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August 2026 Volume 18  Issue 8 IRISHPHARMACYNEWS.IE

THE INDEPENDENT VOICE OF PHARMACY

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In this issue:

GETS TO WORK

NEWS: Medicines Optimisation Support Service Page 5

2x FASTER

REPORT: Common Conditions Service Training Programme Page 12

INTERVIEW: Gwynne Morley on Ireland’s OTC Landscape Page 15

TOP 100: ETS

The annual IQVIA Top 100 OTC Products Page 20

TO WORK

ONE *

2X FASTE R A R A C E TA M

AVAILABLE FROM PHARMACY *Based on absorption data when compared to standard paracetamol tablets. To verify contact: verify@perrigo.com Solpa-Extra 500mg/65mg Soluble Tablets contains paracetamol and caffeine. For the treatment of mild to moderate pain. Adults and adolescents over 16 years: 1-2 tablets dissolved in water every 4-6 hours. Max 8 tablets a day. Adolescents aged 12-15 years: 1 tablet dissolved in water every 4-6 hours. Max 4 tablets a day. Not suitable for children under 12 years. Contraindications: Hypersensitivity to the ingredients. Precautions: Particular caution needed under certain circumstances and medical advice sought for renal or hepatic impairment, Gilbert’s Syndrome, chronic alcoholism, glucose-6-phosphatedehydrogenase deficiency, haemolytic anaemia, glutathione deficiency, malnutrition or dehydration, the elderly, patients weighing less than 50kg. Precautions needed in asthmatic patients sensitive to acetylsalicylic acid, patients on a controlled sodium diet and with rare hereditary problems of fructose intolerance. Patients should be advised not to take other paracetamol containing products concurrently. Immediate medical advice should be sought in the event of overdose even if the patient feels well because the risk of irreversible liver damage. Excessive intake of caffeine should be avoided while taking this product. Interactions: warfarin and other coumarin, other medicines following the same metabolic pathway, cholestyramine, probenecid, chloramphenicol, metoclopramide, domperidone, sedatives, tranquilizers, flucloxacillin and some decongestants. Pregnancy and lactation: Not recommended during pregnancy and breastfeeding. Side effects: Rare: allergies. Very rare: thrombocytopenia, anaphylaxis, bronchospasm, hepatic dysfunction, cutaneous hypersensitivity reactions, very serious skin reactions, TEN, drug-induced dermatitis, SJS, AGEP, sterile pyuria. Unknown: nervousness, dizziness, neutropenia, leukopenia. Further information is available in the SmPC. Product not subject to medical prescription. PA 1186/017/001. MAH: Chefaro Ireland DAC, The Sharp Building, Hogan Place, Dublin 2, Ireland. Date of preparation: Feb 2023. SPC: https://www.medicines.ie/medicines/solpa-extra-soluble-tablets-33783/spc MAT9346

This Publication is for Healthcare Professionals Only

MARKET INSIGHT: Emerging OTC Trends Page 28

CPD: Omega-3 Fatty Acids Page 41

TEAM TRAINING: Stress Page 93

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Contents

Foreword

Page 4: Allcare, Hickey’s and McCauley Pharmacies Raise Over ¤85,000

Welcome to the August issue of Irish Pharmacy News, in which we once again bring you our much-anticipated IQVIA Top 100 OTC Report, providing a comprehensive snapshot of the brands, categories and consumer trends currently shaping Ireland's OTC market.

Page 6: Budget 2027: Enabling Community Pharmacy to Deliver More for Patients Page 9: Pharmacy role set to expand as Government outlines investment

We speak exclusively with Gwynne Morley, General Manager of IQVIA Ireland, who provides her perspective on this year's results and the forces influencing the market. As the figures demonstrate, Irish consumers are becoming increasingly proactive in managing their health, while community pharmacy remains central to supporting informed and appropriate self-care.

Page 12: Developing the Common Conditions Service Training Programme Page 15: IQVIA & IPN Top 100 Market Insight

That role is also reflected strongly elsewhere in this issue.

Page 30: The Pharmacist’s Influence on OTC Purchasing Page 40: Self-Care and the Evolving Role of Community Pharmacy

PUBLISHER: IPN Communications Ltd. 77 Camden Street Lower, Dublin D02 XE80 Office: +353 (01) 2339121

EDITOR Kelly Jo Eastwood: +44 787654 8989 kelly-jo@ipn.ie

DESIGN DIRECTOR Ian Stoddart Design IRISHPHARMACYNEWS.IE

However, expanding pharmacy's contribution must be accompanied by sustainable investment. The Irish Pharmacy Union's pre-Budget 2027 submission calls on Government to properly resource community pharmacy as pharmacists take on greater responsibility for patient care. As IPU President Caoimhe McAuley emphasises, every additional service delivered through pharmacy has the potential to improve access while reducing pressure elsewhere in the health system. Together, these stories demonstrate a profession undergoing significant change. Whether through trusted OTC advice and self-care, prescribing for common conditions or the development of new pharmacy-led services, community pharmacists are increasingly becoming an accessible first point of contact within Irish healthcare.

SALES DIRECTOR Debbie Graham debbiegraham@ipn.ie +353 8727 99317 MARKETING & EDITORIAL EXECUTIVE Anna Hadfield Office: +353 (01) 2339121 Mobile: +353 89 947 7171 anna@ipn.ie

More than 95% of pharmacy businesses in Ireland had registered to participate in the Common Conditions Service (CCS) by May, with 1,827 pharmacies signed up just months after its January launch. The scale of participation demonstrates the profession's willingness to embrace an expanded clinical role and improve access to care within communities across Ireland. We also hear about the collaborative work behind the development of the CCS training programme, ensuring pharmacists were equipped with the knowledge, confidence and understanding of governance required to deliver this important national service.

Page 72: Diabetes Strategy Sets Ambitious Vision

MANAGING DIRECTOR Natalie Maginnis natalie@ipn.ie

Our longstanding collaboration with IQVIA allows us to examine not simply which products are performing strongly, but what the figures tell us about the changing behaviour of Irish consumers. This year's data reveals an OTC market increasingly influenced by self-care, prevention and wellness, alongside the enduring importance of trusted treatments for everyday health needs.

72 Irish Pharmacy News IRISH PHARMACY is circulated to all NEWS independent, multiple Pharmacists and academics in Ireland. All rights reserved by Irish Pharmacy News. All material published in Irish Pharmacy News is copyright and no part of this magazine may be reproduced, stored in a retrieval system or transmitted in any form without written permission. IPN Communications Ltd. has taken every care in compiling the magazine to ensure that it is correct at the time of going to press, however the publishers assume no responsibility for any effects from omissions or errors.

We hope you enjoy this month's issue and, in particular, our 2026 IQVIA Top 100, celebrating the products, brands and evolving consumer trends at the heart of Ireland's community pharmacy market. I hope you enjoy the issue.

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FEATURE: ALZHEIMER’S DISEASE

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TEAM TRAINING: STRESS

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FEATURE: DIGITAL HEALTH

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CLINICAL PR:

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News

Director of Compliance Appointment The Health Products Regulatory Authority (HPRA) has announced the appointment of Ms Katherine Morrow as its new Director of Compliance. Ms Katherine Morrow, Director of Compliance, HPRA

of the national regulator’s mission to protect public and animal health through the effective regulation of health products. Ms Morrow has over 30 years’ experience spanning pharmacy practice, health-professional and medicines regulation, professional education, and competence assurance.

Ms Morrow will lead the HPRA’s compliance department responsible for inspection, licensing, market compliance and enforcement activities, in support

Ms Morrow has held a number of senior leadership positions during her career. She joins the HPRA from APPEL (Affiliation for Pharmacy Practice Experiential Learning) where she held the position of Director and National Coordinator. She recently served as President of the Pharmaceutical Society of

Ireland (PSI), the statutory regulator for pharmacists and pharmacies in Ireland, where she led Council through the development of the PSI Corporate Strategy 2024–2028 and chaired Council and Fitness to Practise proceedings. In her new role as Director of Compliance, Ms Morrow will be responsible for the national inspections programme for health product manufacturers, wholesalers and other regulated entities. She will also be responsible for market surveillance, product defect investigations, product recalls, and the risk-based sampling and analysis of medicines and other health products. The role includes representing the HPRA within European and international regulatory networks, helping to shape and strengthen regulatory standards and compliance practices.

Allcare, Hickey’s and McCauley Pharmacies Raise Over ¤85,000 Allcare, Hickey’s and McCauley Pharmacies, part of the Uniphar Group, are proud to announce that its nationwide “Move Every Day in May” campaign has raised a staggering €85,884.75 for the Irish Heart Foundation. As part of the campaign, participants were encouraged to move every day throughout May, taking part in activities ranging from walking and cycling to dancing, gardening and other everyday movement that supports cardiovascular health. Throughout May, Allcare, Hickey’s and McCauley Pharmacies became community heart-health hubs, hosting weekly “Love Your Heart Days” while the Irish Heart Foundation’s Mobile Health Unit visited selected pharmacies nationwide, providing free hearthealth checks and expert advice to help people take positive steps for their cardiovascular health. Joe Scallan, Retail Director, Uniphar with Emma Balmaine, CEO, Irish Heart Foundation The campaign brought pharmacy teams, customers, and local communities together in May to raise vital funds for heart, stroke and thrombosis support services, while encouraging people of all ages and abilities to build more movement into their daily lives.

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With over 9,500 people dying from cardiovascular disease each year in Ireland and more than 600,000 people living with a cardiovascular condition, the campaign helped to shine a light on the importance of awareness, prevention and practical community-based support.

Joe Scallan, Retail Director, Uniphar said “Our pharmacy teams are at the heart of the communities we serve so it has been incredibly meaningful to see them come together with customers and communities nationwide for this campaign. We are proud to have raised more than ¤85,000 for the Irish Heart Foundation, while helping people take positive steps for their heart health.”

Cancer Treatment at Homet The Cancer Centre at CUH is the first in the country to offer Herceptin in the Home and from last month, eligible patients can self-administer their vital treatment in the comfort of their own house. Herceptin is a lifesaving drug that is used to fight HER-2 positive breast cancer by stopping the cells from spreading and helping the body destroy these cells. Helen O’Shea, Clinical Nurse Specialist and Project Lead explains how it works, “This programme gives people freedom to have treatment at home, and we teach them how to administer the drug themselves at CUH. They have a blood test locally at the GP and once cleared for treatment, it is delivered to them by courier, stored in the fridge and on the appointed day, they can inject themselves at any time and go about their lives. It’s ideal for women who are well used to this treatment already and we will always follow-up with phone calls to see how they are getting on.” HSE South West’s aim is not only to improve access and convenience for patients receiving Herceptin, but also to use the learning from this programme to inform the wider development of home-based and community-supported Systemic Anti-Cancer Therapy (SACT) pathways across Cork and Kerry. Katie Cooke, Pharmacist, CUH added, “By bringing Herceptin directly into our patients' homes, we are giving them their time back. This is about making treatment easier, safer and much more comfortable. It is a first for Ireland; not only is it giving patients freedom back, but it is also freeing up staff and patient capacity at CUH, so we can care for more patients faster.” The Herceptin in the Home programme has been supported by the National Cancer Control Programme (NCCP).

News ¤150m Investment Another significant step in the ongoing development of health services in the northeast of the country, with major developments announced across hospital and community care. Taken together, the announcements represent an investment of over ¤150 million in expanding capacity, modernising facilities and improving access to care for the region’s growing population. Together with other recent projects, they form part of a wider programme of investment to strengthen services across the Dublin and North East region. At Cavan General Hospital, the Minister for Health officially turned the sod on a major extension representing an investment of over ¤100 million. The development will deliver a new Emergency Department, an expanded Endoscopy Unit and 56 additional inpatient beds, significantly strengthening hospital capacity and supporting safer, more timely care for people across Cavan, Monaghan and the wider North East. In Navan, the development of a major new Primary Care Centre will now commence. The sevenstorey facility will bring a broad range of health and community services together in one modern, accessible location, replacing several dispersed sites and supporting more integrated care, while enabling people to access services closer to home. The Minister also officially opened the new 18-bed Willowbridge Ward dementiafriendly ward and took in the new Rehabilitation, Dementia and Remembrance Garden at Monaghan Hospital. These developments provide a more therapeutic, accessible and dementia-inclusive environment, supporting the dignity, independence and wellbeing of patients, and reflecting the region’s focus on improving care for older people. The announcements reflect the HSE’s regional approach to planning and delivering services for a growing and changing population in Dublin and North East. They also support Sláintecare by strengthening hospital capacity and expanding primary and community services so that people can receive the right care, in the right place, as close to home as possible.

More than 95% of pharmacies signed up to Common Conditions Service More than 95% of pharmacy businesses operating in Ireland had signed up to participate in the Common Conditions Service (CCS) by May 2026, according to Minister for Health Jennifer Carroll MacNeill. Responding to a parliamentary question from Deputy Pádraig O’Sullivan, the Minister said 1,827 pharmacies had registered for the service, which launched in January 2026. The CCS is intended to expand the role of primary care and improve access to healthcare, in line with the objectives of Sláintecare. The high level of participation represents a significant uptake by community pharmacies during the service’s first months of operation. The Minister also provided an update on the data collection exercise involving 150 community pharmacies designated as “Data Champions” under the Community Pharmacy Agreement 2025. These pharmacies have agreed to collect and record data

Minister for Health, Jennifer Caroll MacNeill

relating to the operation of the CCS and provide feedback on its implementation. The aim is to build a clearer picture of how the service is working in practice and identify areas that may require further development. However, the Department of Health has yet to analyse the information being gathered. “The data is still in the process of being recorded, collected and will be analysed at a future date,” Minister Carroll MacNeill said.

The session will give participating pharmacists an opportunity to share their experiences and insights into the CCS and help the Department better understand how the service is operating on the ground.

She added that her department is organising an in-person focus group with the Data Champions.

The feedback will also be used to inform future surveys of pharmacies participating in the service.

Medicines Optimisation Support Service Community pharmacists have welcomed agreement on a new Medicines Optimisation Support Service, commencing June 2026. This is a positive step for patients and community pharmacy. It supports a more patient-focused approach, where pharmacists can apply their clinical judgement to ensure medicines are used safely and effectively. The new model allows for more flexible and appropriate supports, tailored to individual patient needs, while also reducing administrative burden and enabling greater focus on patient care. It reinforces the role of pharmacists as medicines experts and ensures that patients who need additional support receive it in a structured and sustainable way. The Irish Pharmacy Union stated, “We look forward to supporting implementation and continued engagement with all stakeholders.” On 1 June 2026, a significant reform of phased dispensing arrangements alongside the introduction of a new patientcentred Medicine Optimisation Support Service, came into effect. The Department of Health, the Health Service Executive (HSE) and the Irish Pharmacy Union (IPU) have agreed to these changes, which are designed to strengthen supports for vulnerable patients who hold a

medical card, and to ensure a more robust system in the future. Advantages of the new supports The reforms see rigid phased dispensing fees replaced with a more flexible patient focused model - which empowers pharmacists to use their professional judgement to support patients most in need. It also reduces administrative burden and further supports the profession in the delivery of frontline patient care. Who can access these supports? Medical card holders in the following vulnerable patient groups may be supported to receive a range of tailored supports, freeof-charge, where the pharmacist deems it clinically appropriate:

• Patients with an intellectual disability. For the purposes of the Medicine Optimisation Support Service, the following definition applies: Intellectual Disability is characterised by lifelong limitations in cognitive and adaptive functioning and experiences of social and environmental restrictions which create barriers to effective participation in daily life.*1 • Patients who, for social inclusion reasons, including homeless or marginalised people, are unable to appropriately manage their medication. • Patients who are on high-risk medicines and are at risk of misuse and/or abuse of those medicines.

• Patients with physical impairment affecting the ability to use conventional packaging (who do not have carers that could support them to use original packs)

Importantly, all patients who were receiving phased dispensing or blister packs free-of-charge prior to the Community Pharmacy Agreement (in August 2025) can continue to do so.

• Patients diagnosed with cognitive impairment or dementia who have carers to support them (including home care) by prompting them to take their medications at the appropriate intervals

*1 Schalock, R. L., Luckasson, R.., & Tassé, M. J. (2021). Intellectual disability: Definition, diagnosis, classification, and systems of supports (12th Edition). Washington, DC: American Association on Intellectual and Developmental Disabilities.

IRISHPHARMACYNEWS.IE

News

Budget 2027: Enabling Community Pharmacy to Deliver More for Patients The Irish Pharmacy Union has called on Government to use Budget 2027 to invest in the expanding role of community pharmacists in delivering patient care, saying pharmacists have the willingness and capability to provide additional healthcare services on behalf of Government if community pharmacies are adequately resourced to do so. Caoimhe McAuley, President, IPU

• Supporting digital transformation; Community pharmacies are among the most accessible parts of the Irish health service, with 1,912 pharmacies across the country and approximately 2.14 million adults visiting a pharmacy every week, equivalent to more than 111 million visits each year. Following the Community Pharmacy Agreement 2025 (CPA25), Ireland’s health services are increasingly depending on pharmacists, as medicines experts, to deliver patient-facing services. This includes the Common Conditions Service, administration of vaccines, engagement in screening programmes and wider public health interventions. The recent publication of the Health (Provision of Contraception Prescribing Service in Retail Pharmacy Businesses) Bill 2026, which will allow pharmacists to issue prescriptions for certain forms of contraception in clearly defined clinical circumstances, is the latest example of Government expanding the role of community pharmacy. Despite this expanded role, the financial model underpinning the community pharmacy network must be strengthened to ensure it reflects rising workforce, regulatory, compliance, operating, and digital infrastructure costs. CPA25 was the first comprehensive review of

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pharmacy funding in almost two decades. To sustain and further expand patient care services, this funding model must now be reviewed on a regular basis rather than being left unchanged for prolonged periods. Commenting IPU President Caoimhe McAuley said, “Community pharmacies are being asked to play an increasingly important role in delivering healthcare closer to home, a role which pharmacists have consistently delivered. Every new service delivered through community pharmacy improves access for patients while helping to reduce pressure on GPs, hospitals, and waiting lists. Pharmacists are ready to do more, but continued expansion can only be achieved if community pharmacies have the sustainable funding needed to deliver those services.” In its pre-Budget submission, the IPU is calling for Government investment to support a sustainable community pharmacy network and enable the continued expansion of patient care. The proposals include: • Establishing a fair and transparent framework for future fee reviews; • Maintaining the real value of State pharmacy remuneration;

• Strengthening workforce capability; • Ensuring fair remuneration for essential pharmacy services; and • Supporting pharmacies serving communities with the greatest health needs. Ms McAuley said, “Pharmacies in disadvantaged communities often support higher numbers of vulnerable and complex patients. These are also communities where access to healthcare can be most challenging and where pressure on other health services is greatest.

“Budget 2027 should include targeted support to protect pharmacy access in these communities. A person’s access to local pharmacy care should not be determined by the level of disadvantage in the community where they live.” Investment in community pharmacy will help protect patient access to care, accelerate digital transformation, and support the delivery of Sláintecare by enabling more care to be delivered in local communities. The IPU said this investment should be viewed not simply as supporting existing pharmacy services, but as creating additional healthcare capacity across the wider health service. Ms McAuley added, “Budget 2027 is a critical opportunity for Government to ensure community pharmacy is properly supported to meet the needs of patients and the wider health service. “This is not simply about sustaining existing services. It is about enabling pharmacies to deliver additional healthcare capacity in communities across Ireland. If Government wants pharmacies to continue expanding this role, there must be a fair and transparent funding framework that reflects the real cost of delivering modern pharmacy services.”

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News

Bringing a “buzz” to Killybegs Enda Lannon, who has been in the pharmacy business for 20 years, says he wanted to bring “a buzz around the place” with the official opening of his latest pharmacy in Killybegs.

Lannon first entered the business in 2006, initially working in Ballysadare alongside his brother, who is also a pharmacist. “Over the years, we have expanded, and this, I am delighted to say, is our fifth pharmacy to open,” he says. “We are looking forward to working with the people and the community of Killybegs.”

The new pharmacy team brings considerable experience to the business, with Lannon highlighting the depth of expertise among his staff.

Lannon also emphasises the importance of becoming part of the local community and supporting existing organisations and initiatives in Killybegs.

“These are all new staff. Between the girls here, we have nearly 100 years of experience, so it is not something we are doing lightly,” he says.

“We have Noel Cunningham, who is a local man in the area. We have the GAA,” he says. “We want to show the community that we are all about supporting local, trying to

bring local people in and bringing a buzz around the place.” The official opening marks the latest step in the expansion of Lannon’s pharmacy business, with the new Killybegs pharmacy aiming to establish itself as a strong part of the local community.

Protecting Medicine Supply The European Parliament has voted in favour of reassessing key elements of the proposed Urban Wastewater Treatment Directive (UWWTD), in a move that has been welcomed by the pharmaceutical sector as an important step towards protecting patient access to essential medicines across Europe. The vote reflects growing concern among policymakers that the current implementation framework for the Directive, particularly the proposed Extended Producer Responsibility (EPR) scheme for pharmaceuticals, may have unintended consequences for the availability and affordability of medicines if introduced without further scrutiny. The UWWTD aims to reduce pollution entering Europe's waterways by requiring advanced treatment of urban wastewater. While its environmental objectives have received broad support, the proposal has become increasingly controversial because of the way the costs of additional wastewater

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treatment would be allocated. Under the current plans, the pharmaceutical and cosmetics industries would be expected to finance the majority of these upgrades through an Extended Producer Responsibility model. However, organisations representing manufacturers of generic, biosimilar and valueadded medicines have argued that the current approach is based on insufficient scientific and economic evidence. They warn that placing substantial additional financial burdens on manufacturers— particularly those producing lowercost generic medicines—could reduce the commercial viability of supplying certain medicines,

potentially leading to shortages or higher prices for patients and healthcare systems. The European Parliament's vote follows growing political momentum for a reassessment of the proposals. Earlier this year, Health Ministers from 17 EU Member States called on the European Commission to gather further evidence on the potential impact of the Directive before implementation proceeds. Their concerns centred on ensuring that environmental ambitions do not inadvertently undermine medicine security across Europe. Medicines for Europe, which represents the generic, biosimilar

and value-added medicines industries, has welcomed Parliament's decision and is urging the European Commission to temporarily pause implementation of the EPR scheme while a comprehensive independent review is carried out. The organisation believes that such a review should examine the methodology used to calculate industry costs, the underlying economic assumptions and the potential impact on medicine availability. It also argues that European and national health authorities, alongside relevant stakeholders, should play a central role in evaluating the proposals before any final decisions are made.

News

Pharmacy role set to expand as Government outlines ¤75m investment and 2026 priorities The Government has outlined a wide-ranging programme of measures aimed at expanding the role of community pharmacy, with €75 million in additional investment being provided under the Community Pharmacy Agreement 2025. Responding to a parliamentary question from Deputy Seán Ó Fearghaíl, Minister for Health Jennifer Carroll MacNeill said significant steps had been taken since January 2025 to strengthen community pharmacy services, with further developments planned throughout the remainder of 2026 and into 2027. The Minister described community pharmacies as “a phenomenal asset” and a major part of Ireland’s health infrastructure, highlighting their accessibility and the trusted role pharmacists play within local communities. The Community Pharmacy Agreement, negotiated between the Department of Health, the HSE and the Irish Pharmacy Union (IPU), provides ¤75 million in additional investment, comprising ¤25 million in 2025 and ¤50 million in 2026. According to the Minister, the agreement is intended to expand pharmacy services, support sustainable funding, modernise service delivery and improve integration between community pharmacy and the wider health system. Common Conditions Service A central development has been the introduction of the Common Conditions Service (CCS), which was publicly launched in January 2026. The service allows participating pharmacists to assess and treat patients presenting with eight specified common conditions, in accordance with approved clinical protocols. Minister Carroll MacNeill said uptake had been strong, with more than 90% of pharmacies delivering the service in their communities. She said the service was improving timely access to care, reducing pressure on GP and urgent care services, and making greater use of pharmacists’ clinical expertise. Structures have also been put in place to evaluate the service later this year, with the Department intending to use the evidence gathered to inform potential future expansion.

The development comes as the role of community pharmacists continues to move beyond traditional dispensing and medicines supply towards a broader range of clinical and public health services.

Deputy Seán Ó Fearghaíl

Contraception prescribing Another major development is the proposed expansion of pharmacists’ role in contraception provision. The Minister recently published the Health (Provision of Contraception Prescribing Service in Retail Pharmacy Businesses) Bill 2026. The legislation is intended to provide the legal framework required to enable pharmacists to prescribe contraception. If enacted, women eligible for the Free Contraception Scheme will be able to access the pharmacy prescription service free of charge. Women outside the scheme, including those aged 36 and over, will also be able to access the service, subject to a locally determined fee. The proposal represents a further expansion of pharmacists’ clinical responsibilities and would integrate pharmacy more closely into women’s healthcare. Vaccination and prevention Vaccination remains another area of expanding pharmacy activity. From 1 May 2026, eligible medical card patients aged over 65 became entitled to receive pneumococcal vaccination free of charge through their local pharmacy. The Department is also engaging with the Health Research Board on research that could inform further expansion of pharmacy-based vaccination services. Alongside clinical services, the Government is increasingly looking to pharmacies as venues for health promotion and disease prevention. A National Condom Distribution Service began a phased rollout in February 2026, with all pharmacies due to be invited to participate by September. Other campaigns taking place through or with the support of pharmacies include alcohol

and pregnancy awareness, men's health and the winter vaccination campaign. A new pharmacy-based element of the National Bowel Screening Programme is also planned. Pharmacies will be able to opt in to promote bowel screening and support people in accessing the programme, with full implementation planned for early 2027. The Department has also made additional grant funding available to support pharmacists undertaking training and professional development as their responsibilities continue to grow. Medicines returns and digital records A new National Medicines Return Service is also due to commence shortly in pharmacies nationwide. The service will allow members of the public to return unused or expired medicines to their local pharmacy for safe disposal. The Department says the initiative will help protect the environment, reduce the risk of suicide and selfharm, and contribute to efforts to tackle antimicrobial resistance. Meanwhile, new legislation signed by the Minister in April 2026 is designed to facilitate greater use of electronic record keeping in pharmacy practice. The legislation provides an alternative to manual, paper-based processes, allowing pharmacies to maintain records digitally where appropriate software safeguards are in place.

The Department says this should reduce administrative burdens and enable pharmacists to spend more time providing clinical care to patients. Focus on collaboration The Government is also seeking to strengthen collaboration between the sector and health authorities. The Strategic Collaboration Group, established under the Community Pharmacy Agreement, brings together the Department of Health, the HSE and the IPU to consider strategic issues affecting the future development of community pharmacy. Two meetings of the group have taken place to date. Taken together, the measures outlined by Minister Carroll MacNeill point towards a continued expansion of the community pharmacist’s role — from medicines supply and advice towards assessment, treatment, prevention, vaccination, screening and medicines optimisation. With significant funding already committed and further services planned for the remainder of 2026 and into 2027, the Government’s stated priority is to make greater use of the accessibility and clinical expertise of community pharmacy while increasing capacity elsewhere in the health system. For pharmacies, the pace of change also brings an increasing focus on training, digital infrastructure, data collection and integration with wider healthcare services as the sector takes on a broader role in delivering care closer to patients’ homes.

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News

Supporting Community Pharmacy Through Smarter Purchasing Investing in Better Pharmacy Solutions Community pharmacy is continually evolving. Alongside delivering expert patient care, pharmacy teams are managing increasing operational pressures, changing regulations and growing expectations around service delivery. Having the right tools and supply partners in place has never been more important. At United Drug, we are committed to helping pharmacies meet these challenges by continually improving the services and solutions available through Pharmax. Guided by member feedback, we continue to invest in the platform to make ordering simpler, improve access to products and support more efficient day-to-day operations. Expanded Access to the Elements EMP Portfolio The latest enhancement sees the full Elements EMP portfolio now available to order directly through Pharmax. This expansion gives members access to the complete Elements EMP range through the Pharmax platform, allowing pharmacies to order through their preferred wholesaler while benefiting from greater flexibility and a broader choice of products. By bringing more of the products pharmacies rely on into one familiar ordering

platform, purchasing becomes simpler and more efficient, helping to reduce administration and save valuable time. Access to the full portfolio also provides improved availability and greater overall value across EMP purchasing. Whether sourcing products for routine requirements or responding to more specialised patient needs, pharmacies can order with confidence through a platform designed to support the realities of a busy dispensary. Confidence Through Compliance Maintaining a secure and compliant supply chain remains a key priority. Pharmax continues to operate in full alignment with HPRA guidance, with no further brokering of Non-EEA products. This provides members with the reassurance that their procurement processes continue to meet the highest regulatory standards while ensuring consistent access to essential products.

Building on Continuous Improvement This latest development builds on the continued evolution of the Pharmax platform. Over the past year, members have benefited from significant enhancements, including the integration of the full United Drug Wholesale portfolio, giving pharmacies access to thousands of additional product lines through a single ordering platform. Combined with Profitlines Plus, pharmacies can now source both dispensary and front of shop products more efficiently, helping to simplify ordering across their business. Alongside an expanded product range, practical features such as dedicated order baskets, Wishlist functionality and next day delivery have been designed to make everyday purchasing quicker and more convenient. While each enhancement may seem incremental, together they

contribute to a more streamlined ordering experience that supports busy pharmacy teams. Supporting Pharmacy Today and Tomorrow At United Drug, we recognise that the needs of community pharmacy continue to change. That is why we remain focused on listening to our customers, strengthening our partnerships and investing in solutions that deliver practical value. Every improvement to Pharmax is made with one goal in mind: helping pharmacies spend less time managing procurement and more time supporting the health and wellbeing of their patients. For more information on the expanded Elements EMP portfolio or the full range of benefits available through Pharmax, speak to your United Drug Area Manager or contact the Pharmax team.

CARA 2026 to Bring Antimicrobial Stewardship Community Together in Dublin Healthcare professionals from across the island of Ireland will gather in Dublin this October for the Fourth All-Island Collaboration: A Multidisciplinary Approach to Antimicrobial Stewardship (CARA 2026). Taking place on 8–9 October 2026 at the Ashling Hotel, Dublin, the conference will bring together healthcare professionals, researchers, pharmacists, microbiologists, infectious diseases specialists and members of the wider antimicrobial stewardship (AMS) community. The event aims to support multidisciplinary learning and collaboration in antimicrobial stewardship, providing a forum for professionals from across Ireland to exchange knowledge, share best practice and explore approaches to improving the safe and effective use of antimicrobials and, ultimately, patient outcomes. Organisers are also inviting abstracts from professionals wishing to showcase their work at the conference. Successful submissions will have the opportunity to present their research, projects or initiatives through either

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a 10-minute oral presentation or a concise three-minute elevator pitch. The abstract programme offers those working across antimicrobial stewardship an opportunity to highlight innovative practice, share experiences with colleagues and contribute to the wider discussion around the continuing development of AMS across the island of Ireland. The conference is supported by organisations including the Northern Ireland Medicines Optimisation Innovation Centre (MOIC) and reflects the importance of crossborder and multidisciplinary collaboration in addressing antimicrobial resistance and promoting responsible antimicrobial use. CARA 2026 will provide an opportunity for professionals involved in antimicrobial stewardship to build connections, exchange ideas and contribute to the continued advancement of AMS practice across Ireland.

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Common Conditions

Developing the Common Conditions Service Training Programme: A Collaborative Approach Reflections from presenting at the International Social Pharmacy Workshop Earlier this summer, I presented a poster at the International Social Pharmacy Workshop on the development of the training programme supporting Ireland's Common Conditions Service (CCS). The introduction of the CCS marked a significant milestone for community pharmacy, enabling pharmacists to prescribe for a defined range of common conditions under agreed clinical protocols. Delivering a new national service at this scale required more than legislation and protocols - it required pharmacists to be supported with high-quality education that built confidence and understanding of the governance underpinning the service. Written by Ailbhe O'Mahoney, Learning and Development Lead, Irish Institute of Pharmacy

itself, but about what cross-sector collaboration actually looks like when you're part of it.

To support implementation, the Department of Health and the Pharmaceutical Society of Ireland (PSI) commissioned the Irish Institute of Pharmacy (IIOP) to develop and deliver a national training programme, working alongside clinical and educational experts from Royal College of Surgeons in Ireland (RCSI). Pharmacists entering the service brought a wealth of existing clinical knowledge, but prescribing within a new national framework required additional preparation. The programme was designed to support confidence in applying the protocols, exercising clinical judgement, and understanding the governance requirements associated with the service.

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Preparing the poster gave me the opportunity to step back from the day-to-day demands of the project and reflect on what it taught me - not just about the training

The phrase "working together" is frequently used in healthcare, but CCS development provided a tangible example of what that looks like in practice. Policymakers at the Department of Health, regulators at PSI and clinical and educational experts

at RCSI each brought different perspectives – governance and implementation priorities, regulatory requirements, and clinical and educational expertise – but much of this work was progressing in parallel rather than in sequence. Rather than one stakeholder handing a finished piece of work to the next, practical considerations, educational requirements and implementation issues were worked through collectively as the service took shape. One of the clearest examples of this was the need to develop educational content while protocols were still evolving. A modular approach to programme design allowed updates to be incorporated as protocols were finalised, without requiring the programme to be redesigned from the ground up. It also provides flexibility to add additional modules should the service be expanded in the future. The experience also challenged something I had previously taken for granted about how education fits into service change. Education is often viewed as something that follows policy once the decisions have been made. In reality, involving educators alongside clinicians and policymakers from the outset meant the programme could evolve

13 opportunities - facing pharmacy are shared internationally. The strongest lesson that emerged for me was the importance of collaboration. Significant professional change rarely happens because of the efforts of one organisation alone; it depends on bringing together different forms of expertise and working towards a shared goal.

alongside a changing service and, at times, helped identify practical questions that informed wider implementation discussions. That approach also influenced how the programme supported pharmacists. CCS was introduced to a profession with varied backgrounds, levels of experience and practice settings. The programme needed to provide

a consistent foundation while recognising that pharmacists would engage with it in different ways and at different stages of their professional careers. Delivered online through modular components, the programme was designed to fit around professional and personal commitments while providing a shared baseline for service delivery.

Feedback from pharmacists throughout rollout proved particularly valuable in identifying where additional clarification, support or guidance was needed. Presenting the poster provided an opportunity to discuss these challenges with colleagues from other countries navigating similar changes in pharmacy practice. What struck me was that people were often as interested in the process as the outcome. Conversations frequently centered on collaboration, change management and implementation challenges rather than the technical details of the programme itself. The poster was subsequently awarded second prize, but perhaps the most valuable aspect of the experience was exchanging ideas with colleagues facing similar challenges internationally. Interestingly, conversations also quickly moved from how the programme had been developed to how widely it had been adopted. With more than 4,000 pharmacists now having completed the programme, colleagues were keen to understand what that level of engagement might indicate about both professional readiness and appetite for an expanded role in practice. While those figures are encouraging, they represent just one part of the story. As CCS continues to evolve, attention will increasingly turn to how the service is delivered in practice, the impact it has for patients and the experiences of pharmacists providing care. Educational supports will need to evolve alongside those developments, ensuring learning remains aligned with both service delivery and the realities of practice. It was encouraging to recognise that many of the challenges - and

A second lesson is one for the profession more broadly. Many pharmacists are involved in service developments, quality improvement initiatives, educational projects and local innovations, yet do not always recognise these as potential conference presentations or publications. Some of the most valuable learning for the profession comes from hearing how colleagues approached a challenge, what worked well, what did not, and what they would do differently next time. Not every conference abstract needs to describe a large research study. Service evaluations, education initiatives, quality improvement projects and implementation experiences can all generate valuable insights and contribute to professional learning. Conferences such as the AllIreland Pharmacy Conference provide an opportunity to share those experiences, learn from others and contribute to the continued development of the profession. The next conference takes place on 12 October 2027, in Ballymascanlon Hotel, Co. Louth - plenty of time to turn a project you're already involved in into something others in the profession can learn from. If the Common Conditions Service has taught us anything, it is that some of the most valuable learning comes not just from research, but from reflecting on, evaluating and sharing what we do in practice every day. Ailbhe O'Mahoney is Learning and Development Lead at the Irish Institute of Pharmacy (IIOP). Having worked in community pharmacy prior to joining the IIOP, she leads the development and delivery of educational initiatives supporting pharmacists in practice, including the training programme for the Common Conditions Service.

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Market Insight

Interview: Gwynne Morley, General Manager, IQVIA Ireland

What is increasingly striking is the strength of categories linked to prevention, digestive health, eye care, skin health, sleep support and intimate care. According to our data, vitamins, minerals and nutritional supplements ranked If we look at the latest IQVIA Ireland third by both volume and value and data over the course of the previous grew by approximately 2.8% and 3.9%, 12 months to April 2026 (May 2025 respectively, while digestive and other April 2026), the Irish over the counter intestinal products ranked fourth and (OTC) market continues to be led by grew by approximately 7.3% in value. Eye everyday conditions, particularly pain care grew by approximately 7.1% in value, relief, cough, cold and respiratory skin treatment increased by approximately 1 products. total OTC value Figure 1 - Top 5The OTC categories byreached value growth 7.5%, calm/sleep/mood enhancement approximately €392.2 million, up 1.6% grew by approximately 7.5%, and urinary versus the same period ending in April and reproductive care delivered one of 2025, while total volume declined by the strongest performances, with value growth of approximately 10.6% and approximately 1.5% to €54.7 million.1 1) What do the latest IQVIA figures tell us about the health concerns currently occupying Irish consumers, and how does this compare with five years ago?

Figure 1 - Top 5 OTC categories by value growth

Gwynne Morley, General Manager, IQVIA Ireland volume growth of approximately 5.3% (Figure 1). Taken together, these trends suggest that Irish consumers are not only treating acute symptoms; they are also taking a more active role in managing longer-term wellbeing, from nutritional support and gut comfort to sleep, eye health, skin health and intimate care.1, 2 Compared with the earlier part of the decade, the market has become less dominated by pandemic-era volatility and more shaped by self-care, resilience and prevention. IQVIA’s OTC Review 2025 – Ireland shows that Ireland saw a sharp post-COVID volume rebound in 2022, Figure 1 - Top 5 OTC categories by value growth

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Figure 2 Total OTC value sales 2

Market Insight

Figure 2 Total OTC value sales followed by a dip in 2023 and a return to growth in 2024. Our current data suggest a more balanced pattern: total market value continued to grow, up approximately 1.6%, despite a 1.5% decline in volume, indicating that consumers remain willing to spend on priority health needs even as they manage purchases more carefully. That tells us the Irish OTC market is no longer only about seasonal illness or acute symptom relief; it is increasingly about prevention, wellbeing, healthy ageing and everyday self-management.1, 2 (Figure 2) 2) The Irish OTC market continues to evolve rapidly. Looking at this year’s category and Top 100 data, what do you believe are the most significant trends shaping consumer healthcare purchasing decisions in Ireland today? For me, there are four standout trends. First, self-care is now deeply embedded in Irish consumer behaviour. More people are comfortable managing common conditions themselves, particularly when supported by a pharmacist. Second, prevention and wellness are moving from niche to mainstream, especially in supplements, digestive health, sleep and other everyday wellbeing categories. Third, consumers appear increasingly value-conscious: market value is growing despite slightly lower volume sales, suggesting continued prioritisation of essential health needs even as purchasing volume remains under pressure. Fourth, pharmacy’s clinical role is expanding, shifting from retail to a trusted point of advice. Those shifts are visible in the 2026 data, where total OTC value grew by approximately 1.6% even though total volume declined by approximately 1.5%, and where several prevention-led categories, including digestive health, sleep, eye care and intimate health, all posted healthy value growth.1

nutritional supplements delivered value health thought leadership. IQVIA’s growth of approximately 3.9%; digestive Consumer Health’s Next Phase global 2) report The Irish continues to evolve rapidly. Looking at this year’s and other intestinal products grew by categor (FebOTC 2026)market notes that behavioural, approximately 7.3% in value; eye care digital forces rapidly and Top and 100economic data, what doare you believe are the most signiﬁcant trends shaping grew by approximately 7.1%; urinary and reshaping how consumers engage with consumer healthcare purchasing in Ireland reproductive caretoday? grew by approximately their health, fundamentally changing decisions 10.6%; calm/sleep/mood enhancement how value is created across OTC Forcategories. me, there are underlying four standout trends. First, is now deeply embedded in Iri grewself-care by approximately 7.5%; and skin A key driver 1 grew by approximately 7.5%. conditio is consumer empowerment: people consumer behaviour. More people are treatment comfortable managing common This signals that Irish consumers are now have more information, tools and themselves, whenhealth supportedinvesting by a pharmacist. Second, prevention a more in proactive health: they confidence toparticularly manage everyday are looking to support immunity, bone needs independently (a true self-care wellness are moving from niche to mainstream, especially in supplements, digesti strength, gut comfort, sleep quality and mindset). This global perspective echoes health, sleep other everyday Third, consumers appe intimatecategories. wellbeing as part of everyday the Irish trendsand above, reinforcing how wellbeing self-care. This aligns with broader trends; deeply embedded self-care habits, increasingly value-conscious: market value is growing despite slightly lower volum for example, IQVIA’s Ireland OTC review mainstream preventive wellness, valuesales, suggesting continued prioritisation of essential health needs even as purchasi found nearly half of Irish adults use conscious choices and the pharmacist’s supplements regularly, with is Vitamin D the shifti trustedremains role are part of apressure. broader shift in volume under Fourth, pharmacy’s clinical role expanding, most popular, and it notes that Ireland’s consumer health.4 from retail to a trusted point of advice. Those shifts are visible in theboost 2026 data, whe ageing population will further 3) Consumers are increasingly focused demand for healthy-ageing total OTC value grew by approximately 1.6% even though totalproducts. volume5 declined on prevention, wellness and healthy approximately where several prevention-led including digesti The medium-termcategories, forecast reinforces ageing. Are we1.5%, seeing and evidence of this This pattern is expected to continue over this withhealthy vitamins, minerals and (1). shift within rankings, and health, the medium term, with IQVIA’s 2025– health, sleep,the eyeOTC care and intimate allshift, posted value growth nutritional supplements, skin treatment which categories are benefiting most 2030 outlook pointing to stronger value and digestive health all projected to from this trend? growth than volume growth, suggesting a continue expanding through 2030.3 combination of real demand, pricing and 2 Source: IQVIA RetailThe Sell-in data April 2026 Yes, very clearly. categories most mix effects.3 That direction is also supported by aligned to prevention and healthy ageing IQVIA’s broader consumer health work. are performing well. In MAT April 2026 That broader pattern is also consistent IQVIA’s “Unlocking Opportunities in with IQVIA’s 2025 and 2026 consumer Ireland data, vitamins, minerals and

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GLP-1 Obesity Patients Split by Funding Scheme Dec 25

Figure 3 GLP-1 obesity patients split by funding scheme, December 2025 health ecosystem, where nutrition, supplementation, beauty, fitness and wellbeing become part of the routine.8 That means the impact on OTC is both direct — through decline in traditional weight-loss lines — and indirect, through new opportunities in nutritional support, digestive tolerance, hydration, energy and metabolic wellbeing. The logic is simple: if consumers now view weight management as part of an overall lifestyle transformation (not just a pill or injection), companies must package their science in ways that resonate with everyday life. In short, the winners will combine medical credibility with consumer relevance – packaging treatments within supportive lifestyle ecosystems that help patients get healthier overall. 9, 8, 10

the Healthy Aging Market” webinar frames the ageing population as a major innovation and growth opportunity for consumer health, with real-world evidence, category consumption and brand strategies increasingly focused on helping people live longer, healthier lives.6 4) Weight management has become one of the biggest healthcare talking points of recent years, driven in part by the growth of GLP-1 medicines. Has this had any noticeable impact on OTC purchasing behaviour, either directly or indirectly? Yes — and the impact on OTC is becoming increasingly visible. Over the course of the previous 12 months to April 2026 (May 2025 - April 2026), IQVIA Ireland data, the OTC traditional weight-loss aid category represents a very small part of the market and declined again, falling by approximately 17.2% in volume and 10.6% in value. The internal IQVIA Ireland OTC landscape draft

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confirms the decline in traditional OTC weight-loss products and links this trend to growing consumer interest in prescription-based obesity treatments, including GLP-1 receptor agonists, which are often accessed privately due to limited public reimbursement.1 The rise of GLP 1 therapies has been dramatic. Use of these treatments increased by 74% over the course of 2025, driven largely by a private market in which, in December 2025, the majority of prescriptions were paid for out of pocket (84%) (Figure 3). Uptake has been strongest among women, particularly those aged 36–55, highlighting how weight management is increasingly being approached as a long term, self funded health decision rather than a short term fix.7 What is especially important is that GLP-1s are not just taking share from legacy OTC weight-loss products; they are reshaping adjacent consumer behaviour. IQVIA also notes that GLP1 use is creating a broader consumer

What is also changing is how companies communicate with consumers. Traditionally, OTC brands have been built around a relatively singular clinical proposition. Increasingly, however, we are seeing the emergence of broader “platform” approaches — where science is only one part of a more holistic, lifestyleoriented experience. These platforms are multidimensional, more personal and often digitally enabled, combining treatment, nutrition, content, coaching and community. The companies gaining attention are not those moving away from science, but those packaging scientific credibility within more consumerrelevant, everyday experiences. Over time, success will not come from choosing between medical credibility and consumer resonance, but from combining both.8, 10 5) Community pharmacy continues to expand its clinical role through vaccination services, health screening and Pharmacy First-style initiatives. What impact, if any, are these developments having on OTC category performance and consumer behaviour? They are having a clear impact. As a pharmacist myself, I’ve seen how new pharmacy services are making the local pharmacy the first port of call for many everyday health concerns. IQVIA’s Ireland market review shows that pharmacies across Ireland now offer

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Market Insight additional services including emergency contraception, seasonal vaccinations, consultations and health screening as core services. The launch of the Common Conditions Service (CCS) in January 2026 marks a significant milestone in this evolution, enabling trained community pharmacists to assess, advise and, where clinically appropriate, prescribe treatments for eight common conditions, including cold sores, conjunctivitis, uncomplicated urinary tract infections and shingles. This service is designed to improve access to timely care, support self-management and reduce pressure on GP and hospital services. The IPHA Survey shows that 87% of respondents said they would happily visit a pharmacy rather than a GP for advice on minor health needs.5 From a market perspective, that clinical expansion supports OTC growth by bringing more consumers into pharmacy for timely assessment and appropriate product guidance. The internal IQVIA Ireland OTC draft explicitly connects the expanding role of pharmacy with OTC demand, while the current category data show strong growth in areas where pharmacist advice matters — including digestive health, eye care, urinary and reproductive care, skin treatment and habit treatment.2 6) The cost-of-living crisis has influenced spending habits across many sectors. Are consumers becoming more priceconscious in their OTC purchasing decisions, and are we seeing any shift between branded products and ownlabel alternatives? Consumers are certainly more priceconscious, and one of the clearest signs is the divergence between value growth and volume growth. Over the course of the previous 12 months to April 2026 (May 2025 - April 2026), IQVIA Ireland data, total market value rose by approximately 1.6% while volume fell by approximately 1.5%. We see similar patterns in major categories such as pain relief and cough, cold and respiratory products, where volumes declined and value also softened, although less dramatically in pain relief.1 IQVIA’s consumer health analysis has consistently highlighted inflation and consumer restraint as important forces.

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The 2025 global OTC commentary notes that inflation, weaker cough/cold demand in some markets and more cautious spending have affected volumes, while pricing has contributed much more to growth than underlying volume. The Ireland review also says patients are seeking affordable, effective and sustainable healthcare solutions, including generic alternatives, and that valueconsciousness is now a defining trait of the consumer. What we can say confidently from the evidence is that price sensitivity is rising; however, the available data does not explicitly show the exact split between brands and own-label, so we should avoid overstating that point beyond saying that affordability is becoming more important in purchase decisions.11, 4 7) Women’s health has received increased attention in recent years, particularly around menopause, menstrual health and intimate health. Are there any notable trends or growth areas emerging within these categories? Yes, there are encouraging signs, particularly in intimate and reproductive health. In the MAT April 2026 IQVIA Ireland data, the urinary and reproductive care category grew by approximately 10.6% in value and 5.3% in volume, making it one of the faster-growing areas of the OTC market. The category-level data therefore supports momentum in urinary and reproductive care, although more granular product-class data would be needed to quantify menopause, menstrual health or specific intimatehealth subsegments confidently.1 The robust, evidence-based conclusion is that women’s health-adjacent OTC demand is growing, especially in intimate and reproductive care, and that those categories are benefiting from wider social openness, pharmacist support and greater consumer willingness to self-manage. This is also consistent with broader consumerhealth trends around prevention, self-care and pharmacist-supported access.2, 5, 4 8) Looking at the Top 100 rankings, were there any surprise performers or categories that exceeded expectations over the past 12 months? A few areas really stood out at category level. Urinary and reproductive care (+10.6%), skin treatment (+7.5%), digestive

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health (+7.3%), eye care (+7.1%) and calm/ sleep/mood enhancement (+7.5%) all outperformed the overall market in value growth, and that is significant because it points to sustained demand beyond the traditional cough/cold and pain cycle. Habit treatment also remained resilient, with broadly flat value sales despite lower volume, reinforcing the publichealth relevance of nicotine replacement and cessation support. For me, those are important signals because they show that Irish consumers are continuing to prioritise proactive self-care, symptom management and pharmacist-supported solutions across a broader range of everyday health needs.1 At product level, the strongest signals appear to reflect broader consumer needs rather than isolated product outliers. The Top 100 rankings show momentum across products associated with eye care, hydration and electrolyte support, digestive comfort, laxatives, haemorrhoid and anorectal care, men’s sexual health, intimate health and probiotic supplementation. Rather than overinterpreting individual products, the more robust conclusion is that consumer need is moving toward gut comfort, hydration, eye care, intimate health and discreet pharmacist-supported solutions. That is also consistent with IQVIA’s broader consumer-health perspective, which highlights the growing role of self-care, prevention, personalisation and pharmacist engagement in shaping OTC growth.2, 5, 4 9) Innovation remains critical within the consumer healthcare market. Which categories are currently attracting the greatest levels of innovation, and how important is innovation in driving growth within the OTC sector? Innovation remains particularly important, but IQVIA’s own analysis makes a key point: innovation only drives growth when it is relevant to changing consumer need. In IQVIA’s 2026 consumer health report, the “Freshness Index” suggests that only a relatively small share of sales in key OTC categories comes from recently launched products — roughly 10% to 16% depending on the category. That means the sector still depends heavily on established products and trusted categories, but it also means that smart innovation can be

disproportionately powerful where it solves a real everyday need.4 In Ireland today, the most visible innovation spaces are digestive health, personalised and preventative wellness, eye care, sexual health and the broader GLP-1 support ecosystem. At productclass level, this includes innovation around digestive comfort and irritable bowel symptom relief, personalised supplementation, lubricating and dualaction eye care, OTC men’s sexual-health medicines, and adjacent solutions for people using GLP-1 therapies, including nutrition support, digestive tolerance, hydration, energy and wellbeing. For me, innovation matters — but the real winners will be the companies that innovate around consumer routines, pharmacist engagement and tangible outcomes rather than just launching new SKUs. That is where innovation becomes meaningful: when it combines clinical credibility with consumer relevance and fits naturally into how people manage their health day to day.5, 4, 8 10) Looking ahead to the next three to five years, what do you believe will be the biggest opportunities and challenges for the Irish OTC market, and what role will community pharmacy play in shaping its future? The opportunity is very strong. Over the next three to five years, the Irish OTC market is expected to continue growing, with IQVIA’s 2025–2030 outlook projecting value growth from approximately €486 million in 2025 to €611 million by 2030, alongside more moderate volume growth from around 69.7 million to 79.4 million units.3 This points to a market supported by both real demand growth and pricing or mix uplift. Growth is likely to be driven by the categories closest to everyday consumer need, including digestive health; cough, cold and respiratory care; pain relief; healthy ageing; eye care; intimate and reproductive health; and broader self-care support. The fundamentals behind that outlook are clear: an ageing population, rising comfort with self-medication, digitally informed consumers and increasing demand for accessible care close to home.5

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The challenges are real too: affordability pressure, uneven consumer spending, regulatory uncertainty in selected pharmacist-supplied medicines, possible EU reverse-switching of some antifungal and antiviral products, and growing competition from online and non-traditional channels. But for me, community pharmacy is the market’s biggest strategic advantage. As a pharmacist myself, I know how often people come into the pharmacy first for common, everyday conditions — coughs and colds, pain, digestive discomfort, eye irritation, skin complaints, smoking cessation support, intimate health concerns and minor urinary symptoms — because they want timely advice from someone they trust. The more pharmacy evolves from a place where people collect medicines to a trusted neighbourhood care hub — offering advice, vaccination, screening, triage and appropriate OTC recommendation — the stronger the OTC market becomes. In that sense, pharmacy will not simply respond to the next phase of Irish OTC growth; it will actively shape it.2, 5, 3

“What the latest IQVIA data shows very clearly is that Irish OTC is no longer just about treating everyday symptoms. It is increasingly about prevention, personalised wellbeing and accessible pharmacy-led care. The categories growing fastest are those aligned to how consumers now want to manage their health — proactively, conveniently and with trusted support from their local pharmacist. Looking ahead, that combination of wellness-led demand, balanced market growth and pharmacy accessibility will be central to shaping the next phase of consumer healthcare in Ireland.”1, 2, 5, 3

References 1. IQVIA Consumer Health Market Data, Preliminary 2026 – Total OTC market value & growth estimate. 2. IQVIA OTC Database - Ireland (MAT April 2026). 3. IQVIA OTC Review 2026 – Ireland. 4. IQVIA “Consumer Health’s Next Phase” – Global analysis highlighting behaviour, digital influence, and economic pressures redefining consumer health engagement. [Online] February 2026. https://www.iqvia. com/-/media/iqvia/pdfs/library/ publications/2026/consumer-healthsnext-phase-iqvia-consumer-health.pdf 5. IQVIA OTC Review 2025 – Ireland Ireland market analysis confirming core category leadership. 6. IQVIA. Webinar - Unlocking Opportunities in the Healthy Aging Market. [Online] https://www.iqvia. com/events/2024/06/unlockingopportunities-in-the-healthy-agingmarket . 7. IQVIA LRx GLP-1 Tracker, Jan 2024 Dec 2025. 8. S., Krammer-Lukas. The ne w shape of consumer health. IQVIA Blog. [Online] May 2026. https://www.iqvia. com/blogs/2026/05/the-new-shape-ofconsumer-health. 9. Nutrition as the Keystone for Obesity Management Medication. [Online] 2025. https://www.iqvia.com/library/ white-papers/nutrition-as-thekeystone-for-obesity-managementmedication. 10. Emerging Opportunities for Consumer Health in the CVRMET Space. Blog. [Online] 2026. https://www.iqvia. com/locations/emea/blogs/2026/04/ emerging-opportunities-for-consumerhealth-in-the-cvrmet-space. 11. Navigating an Uncertain Future: Strategic Insights from 2024 Global OTC Performance. [Online] https:// www.iqvia.com/blogs/2025/05/ navigating-an-uncertain-future.

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One of the strongest performances came from urinary and reproductive care, which increased by approximately 10.6% in value and 5.3% in volume. As Gwynne explains, consumers are no longer purchasing OTC products solely in response to acute symptoms. Increasingly, they are taking a proactive approach to

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*Disclaimer: Please note that the seven year comparison listed opposite details a range from Jan-April for the years 2021-26 and from Jan-May for 2025. These, along with other comparisons with previous years, may include brands and categories whose classification may have changed over that period. The IPN/IQVIA Top 100 OTC products and the method of its collation evolves with the pharmacy.

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Over the following pages, the IPN/ IQVIA Top 100 OTC Report 2026 examines the brands, categories and consumer trends shaping this changing marketplace – and highlights where the opportunities may lie for community pharmacy in the years ahead.

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Eye care recorded value growth of approximately 7.1%, skin treatment increased by approximately 7.5%, and calm, sleep and mood enhancement also grew by approximately 7.5%.

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Categories associated with prevention and longer-term wellbeing are demonstrating particularly positive momentum. Vitamins, minerals and nutritional supplements grew by approximately 3.9% in value, while digestive and other intestinal products increased by approximately 7.3%.

The expansion of pharmacy-led healthcare services, including vaccination, screening and the introduction of the Common Conditions Service in January 2026, is increasingly positioning community pharmacy as a first point of contact for everyday healthcare needs.

Pain relief and cough, cold and respiratory products continue to lead the market, but some of the most interesting developments this year are occurring beyond these traditional OTC mainstays.

PARACETAMOL 500mg CODEINE 8mg CAFFEINE 30mg

At the same time, economic pressures continue to influence purchasing decisions. The divergence between rising market value and declining volumes suggests that consumers remain willing to prioritise spending on important health needs, but are becoming increasingly considered about what and how much they purchase.

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According to the latest IQVIA Ireland data, the Irish OTC market reached a total value of approximately ¤392.2 million in the 12 months to April 2026, representing value growth of approximately 1.6% compared with the corresponding period to April 2025. At the same time, total volume declined by approximately 1.5%, illustrating an increasingly value-conscious consumer environment.

Self-care itself has become more firmly embedded within Irish consumer behaviour, with people increasingly comfortable managing common and everyday conditions themselves, particularly when supported by the advice of their community pharmacist.

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To explore the trends behind the numbers, Irish Pharmacy News once again spoke with Gwynne Morley, General Manager of IQVIA Ireland, to gain her insights into this year's results, changing consumer behaviour and the future opportunities for Ireland's community pharmacy sector.

areas such as nutritional support, digestive health, sleep, eye health, skin health and intimate wellbeing.

Products in units (000s)

The 2026 Top 100 Over-theCounter (OTC) Market Report is compiled using IQVIA's audited OTC data, based on the value of wholesale sales of OTC products into retail pharmacy over the 12 months to April 2026 (May 2025– April 2026).

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Irish Pharmacy News has been working with leading healthcare data and analytics company IQVIA for more than a decade to compile our annual report highlighting the Top 100 Over-the-Counter pharmacy brands in Ireland.

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04/2025

05/2026

04/2021

04/2022

04/2023

04/2024

04/2025

05/2026

04/2021

04/2022

04/2023

04/2024

04/2025

05/2026

Pharmacy Products IMODIUM

26 26 39 47 42 67

VICKS

51 48 48 38 43 88

SILCOCKS BASE OVE

76 71 80 88 77 42

THEALOZ DUO

27 37 38 41 50 41

SINUTAB

52 45 44 50 46 74

AYA ELECTROLYTE

SUDAFED NASAL

28 25 27 30 44 54

RENNIE

53 53 52 68 67 80

CORSODYL

78 80 79 81 65 51

PANADOL ACTIFAST

29 32 34 35 35 47

ROWALIEF

54 69 94 76

HYLO DUAL

MOTILIUM

30 29 30 26 34 43

DEEP HEAT

55 46 41 48 51 38

CALDESENE

80 76 77 60 56 48

STREPSILS

31 27 23 19 27 70

NIQUITIN

56 54 53 59 54 46

ALFLOREX

81 74 76 74 66 65

EMAZOLE CONTROL

VOLTAROL

57 50 42 43 33 19

LYCLEAR WEL

82 95 88

BUSCOPAN IBS

33 49 56 53

REVIVE ACTIVE

58 61 62 64 82

VIAGRA CONNECT

83 83 81 80 79

DULCO LAX

34 36 22 34 75 24

GAVISCON EXTRA STR

59 60 72 89 80 89

IMODIUM PLUS

84 84 63 69

BENYLIN DAY NIGHT

35 33 36 32 68

PANADOL NIGHT

60 57 58 54 48 60

BEPANTISEPTIC

85 87 84 85 81 87

PARACETAMOL BF&

BONJELA

61 62 59 66 61 53

HYLO NIGHT

86 77

ANTI HIST ALLERGY

37 35 40 45 47 37

NUROFEN EXPRESS

62 52 46 36 26 26

MYBUFEN MAX

OTRIVINE

38 38 29 33 37 30

SAVLON CLH

63 63 70 83 64 66

ACIC

88 86 69 92 94

NUROFEN COLD & FLU

39 31 32 42 45

BROLENE

64 72 64 87

VIVIO JUNIOR

89 85 78 72 78

SENOKOT

40 44 66 44 32 21

BRONCHOSTOP JUNIOR

65 58 54 40 49 86

OPTIBAC

PANADOL

41 43 37 27 16 28

BEROCCA

66 64 65 58 54 52

ULTRAPURE

DIFFLAM

42 30 33 28 38 69

SUDOCREM

67 59 75 73 63 63

ARTELAC

92 89 82 93 60 55

PIRITON

43 39 31 39 31 17

BENYLIN DRY N/D

68 56 57 57 72

STERIMAR

93 94

NEXIUM CONTROL

44 34 25 21 17 12

CYSTOPURIN

69 68 67 71 70 71

CALPOL VAPOUR

94 92 91 62 52 56

CORTOPIN

45 47 49 51 73 93

ARRET

70 70 68 75 84

THERMACARE

95 81 86

PARACETAMOL GKC

46 55 50 33 96

ILVICO

71 82 92

BENYLIN CHESTY N/D

96 79 85 57 72

ZIRTEK

47 41 45 37 40 49

ACTIFED

72 65 61 56 58 94

NICOTINELL

97 67 74 76 62 58

NUROFEN

48 42 35 22 18 13

CERUMOL

73 73 71 77 74 75

ANUSOL

98 90 89 95 92 85

VERMOX

49 51 51 63 59 45

FYBOGEL

74 75 73 55 57 44

BEPANTHEN

99 96

TELFAST ALLERGY

50 40 43

ZOVIRAX

75 78 90 84 69 82

E 45

100 100 0

IRISHPHARMACYNEWS.IE | 21

Marketing Insight: Pain Relief

Acute Pain Management: Guiding Patients Through the OTC Analgesia Maze Pain is one of the most common reasons patients seek advice in community pharmacy. Whether it is a headache, dental pain, muscle strain or sprained ankle, pharmacists are often the first healthcare professionals patients turn to for prompt, effective relief. Written by Fatimah Kara, Supervising Pharmacist, Reidy’s Pharmacy, Rathcoole

can delay recovery and, in some cases, contribute to the development of chronic pain. Chronic pain Chronic pain is generally defined as pain that persists beyond normal tissue healing, typically for longer than three months.

ensuring appropriate treatment while identifying those who require referral for further assessment. Understanding Acute and Chronic Pain Pain is broadly classified as either acute or chronic. Acute pain The World Health Organization (WHO) adopts the International Association for the Study of Pain (IASP) definition of pain as: "An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage." Importantly, pain is not simply a physical sensation. Both the WHO and IASP recognise that pain is a highly personal experience influenced by biological, psychological and social factors. Two patients with the same injury may experience pain very differently, making empathy, active listening and individualised assessment essential components of effective pain management. Community pharmacists are uniquely placed to help patients navigate the wide range of over-thecounter (OTC) analgesics available,

Acute pain develops suddenly and usually has an identifiable cause. It serves as the body's natural warning system, alerting us to injury or illness. In most cases it resolves once the underlying cause has healed. Common causes of acute pain include: • Headache • Toothache and dental procedures

As chronic pain management usually involves prescription medicines alongside physiotherapy, psychological support and specialist care, this article focuses on the OTC management of acute pain, where community pharmacists can make a significant difference. Assessing the Patient Before recommending any analgesic, pharmacists should establish both the cause of the pain and the patient's expectations.

• Where is the pain?

• Cuts, burns and bruises

• How severe is it?

• Fractures

• How long has it been present?

• Kidney stones

• What caused it?

• Sore throat

• What treatment has already been tried?

• Post-operative pain • Labour and childbirth Although acute pain is usually short-lived, inadequate treatment

COMING SOON.....

Persistent pain can have profound effects on quality of life, contributing to reduced mobility, fatigue, disturbed sleep, anxiety and depression.

Questions should include:

• Sprains and strains

NEW LAUNCH

Unlike acute pain, chronic pain often becomes a condition in its own right and requires long-term management by a multidisciplinary healthcare team. Conditions commonly associated with chronic pain include arthritis, chronic back pain, fibromyalgia, endometriosis, neuropathic pain and cancer.

• Does the patient have any medical conditions or take regular medication?

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Understanding what the patient hopes to achieve is equally important. Many are looking for rapid pain relief, while others prioritise long-lasting symptom control or improved mobility. Current guidance recommends treating the underlying cause whenever possible and ensuring analgesics are used at an appropriate therapeutic dose before switching to an alternative medicine or adding another agent. Although the HSE encourages selfcare for many acute conditions— including headaches, minor injuries and musculoskeletal pain—the ever-growing range of OTC products can leave patients unsure which option is most appropriate. This is where the expertise of the pharmacy team is invaluable. Choosing the Right Analgesic Selecting the most appropriate analgesic depends on the type of pain, the patient's medical history and the presence of inflammation. Paracetamol Paracetamol remains a firstline option for many patients experiencing mild to moderate pain. It is effective for headaches, fever and general aches and pains and is generally well tolerated. However, it has no anti-inflammatory effect, making it less suitable where inflammation is the primary cause of pain. Pharmacists should always ask about other prescription and OTC medicines, as many combination products also contain paracetamol, increasing the risk of accidental overdose. For adults, treatment usually starts at 500 mg to 1 g every four to six hours, with a maximum daily dose of 4 g in appropriate adults. Lower maximum doses may be required in older patients, those with low body weight or those with liver impairment.

Marketing Insight: Pain Relief

Non-steroidal Anti-inflammatory Drugs (NSAIDs)

• Only for short-term management of acute pain

• Interferes significantly with normal daily activities

Where inflammation is contributing to pain, NSAIDs such as ibuprofen are often the preferred option.

Patients should also be informed about potential adverse effects including constipation, drowsiness and nausea, together with the risk of dependence if used repeatedly or for prolonged periods.

• Is associated with recurrent episodes without an obvious cause

Ibuprofen is effective for conditions including: • Musculoskeletal injuries

The Role of Topical Analgesics

• Dental pain

Topical analgesics offer an effective alternative for many patients, particularly those experiencing localised musculoskeletal pain.

• Period pain • Back pain • Soft tissue injuries Adults can usually start with 200–400 mg three times daily, up to a maximum OTC dose of 1,200 mg daily. However, NSAIDs are not suitable for everyone. They should be avoided in patients with: • Active peptic ulcer disease or gastrointestinal bleeding • Previous NSAID-induced GI bleeding • Severe heart failure • Significant renal impairment • NSAID hypersensitivity • Certain patients with asthma A careful medical history should always be taken before recommending an NSAID. When Should Codeine Be Considered? Codeine-containing medicines remain available over the counter in Ireland when combined with paracetamol or ibuprofen. However, they should not be considered first-line treatment. According to PSI guidance, codeine-containing medicines should only be supplied under the direct supervision of a pharmacist after other suitable analgesics have proved ineffective.

Because they act directly at the site of pain, they produce lower systemic drug exposure than oral medicines and are associated with fewer systemic adverse effects. Common options include topical NSAIDs such as diclofenac and ibuprofen gels, which are particularly useful for sprains, strains and joint pain. Counterirritants containing ingredients such as menthol or methyl salicylate provide temporary relief by stimulating sensory nerve endings, producing cooling or warming sensations that help reduce the perception of pain.

• Urinary retention • Saddle anaesthesia • Unexplained weight loss • Fever • Severe night pain • Suspected fracture • Signs of infection • Neurological deficit The Pharmacist's Role Community pharmacists are ideally placed to support patients

As self-care continues to expand and the range of OTC analgesics grows, keeping up to date with clinical guidance is essential. Through evidence-based recommendations and patientcentred care, pharmacy teams can help patients achieve effective pain relief while ensuring safe and appropriate management of acute pain.

OTC ibuprofen medicated patches provide prolonged local delivery of anti-inflammatory medication, while drug-free heat and cooling patches offer suitable alternatives for patients unable to take oral analgesics. When to Refer Although many cases of acute pain can be managed successfully in community pharmacy, recognising when referral is required is equally important. Patients should be referred to their GP if pain:

Codeine should be used:

• Persists beyond expected healing

• For no longer than three consecutive days

• New bladder or bowel dysfunction

Beyond recommending effective OTC analgesics, pharmacists play an important role in educating patients about appropriate medicine use, preventing inappropriate opioid use, identifying contraindications and recognising when referral is necessary.

Heat therapy products can also play an important role. Heat patches increase local blood flow, helping to relax tight muscles and relieve muscular discomfort.

Patients should be counselled carefully about appropriate use.

• At the lowest effective dose

Urgent medical assessment is required if patients present with red flag symptoms, including:

experiencing acute pain. Every presentation is unique, and selecting the most appropriate treatment requires careful assessment of symptoms, medical history and patient expectations.

• Lasts longer than 12 weeks • Is progressively worsening

(https://www.researchgate.net/publication/326400204/figure/fig1/AS:648 351003455488@1531590333421/WHO-analgesic-ladder-for-malignancyassociated-pain.png)

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Paracetamol

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• Earache • Aches & Pains • Sore Throat • Headache • Toothache

Calpol Six Plus Fastmelts 250 mg Paracetamol Orodispersible Tablets. Composition: Each tablet contains 250mg paracetamol. Orodispersible tablet. Indications: For the treatment of mild to moderate pain such as headache, teething pain and sore throat, and as an antipyretic (e.g. fever associated with colds and flu). Dosage: Under 6 years: Not recommended. 6 – 9 years: 1 tablet 4 times in 24 hours. 9 – 12 years: 2 tablets 4 times in 24 hours. 12 – 16 years: 2 to 3 tablets 4 times in 24 hours. Adults and children over 16 years: 2 to 4 tablets 4 times in 24 hours. Do not give more than 4 doses in any 24-hour period. Leave at least 4 hours between doses. Do not give this medicine to your child for more than 3 days without speaking to your doctor or pharmacist. Calpol Six Pus 250 mg/5 ml Sugar/Colour Free Oral Suspension Composition: 250 mg paracetamol in each 5 ml Indications: Calpol products are indicated for the treatment of mild to moderate pain and as antipyretics. Calpol is indicated for the symptomatic relief of headache, migraine, neuralgia, toothache and teething pains, sore throat, influenza, feverishness and feverish colds. Dosage: Do not give to children under 6 years of age. Children aged 6 years – 12 years: 6 – 8 years: One 5 ml spoonful (large end) (4 times in 24 hours). 8 – 10 years: One 5 ml spoonful (large end) and one 2.5 ml spoonful (small end) (4 times in 24 hours). 10 - 12 years: Two 5 ml spoonful (large end) (4 times in 24 hours). Children aged 12 – 16 years: Two – three 5ml spoonfuls (large end) up to 4 times a day. Adults and children over 16 years: Two – four 5ml spoonfuls (large end) up to 4 times a day. Do not give more than 4 doses in any 24-hour period; Leave at least 4 hours between doses; Do not give this medicine to your child for more than 3 days without speaking to your doctor or pharmacist. It is important to shake the bottle for at least 10 seconds before use. Renal impairment: It is recommended, when giving paracetamol to patients with renal impairment, to reduce the dose and to increase the minimum interval between each administration to at least 6 hours unless directed otherwise by a physician. Recommended Dose for Adults with Renal Impairment: Glomerular filtration rate10-50 ml/min: 500 mg (2 tablets / 10ml) every 6 hours. Glomerular filtration rate <10ml/min: 500 mg (2 tablets / 10ml) every 8 hours Hepatic impairment: In patients with hepatic impairment or Gilbert’s Syndrome, the dose should be reduced or the dosing interval prolonged. For adults, the daily dose should not exceed 2g per day unless otherwise directed by a physician. The Elderly: Experience has indicated that normal adult dosage is usually appropriate. However in frail, immobile, elderly subjects or in elderly patients with renal or hepatic impairment, a reduction in the amount or frequency of dosing may be appropriate. For certain patient groups, a reduced maximum daily dose should be considered unless directed by a physician: Patients who are underweight (for adults, those under 50kg); Chronic alcoholism; Dehydration; Chronic malnutrition. For adults the maximum daily dose should not exceed 60mg/kg/day (up to 2g per day). Contraindications: Hypersensitivity to the active substance or to any of the excipients. Calpol Six Plus Fastmelts: are contra-indicated in patients with phenylketonuria. Special Warnings and Precautions for Use: Paracetamol should be administered with caution under the following circumstances: Hepatic impairment; Chronic alcoholism; Renal impairment (GFR≤50ml/min); Gilbert’s Syndrome (familial non-haemolytic jaundice); Concomitant treatment with medicinal products affecting hepatic function; Glucose-6-phosphate dehydrogenase deficiency; Haemolytic anaemia; Glutathione deficiency; Dehydration; Chronic malnutrition; Patients who are underweight (for adults, those under 50 kg); Elderly. In general, medicinal products containing paracetamol should be taken for only a few days without the advice of a physician or dentist and not at high doses. If high fever or signs of secondary infection occur or if symptoms persist for longer than 3 days, a physician should be consulted. Prolonged or frequent use is discouraged. Patients should be advised not to take other paracetamol containing products concurrently. Taking multiple daily doses in one administration can severely damage the liver; in such cases medical assistance should be sought immediately. Cases of high anion gap metabolic acidosis (HAGMA) due to pyroglutamic acidosis have been reported in patients with severe illness such as severe renal impairment and sepsis, or in patients with malnutrition or other sources of glutathione deficiency (e.g. chronic alcoholism) who were treated with paracetamol at therapeutic dose for a prolonged period or a combination of paracetamol and flucloxacillin. If HAGMA due to pyroglutamic acidosis is suspected, prompt discontinuation of paracetamol and close monitoring, is recommended. The measurement of urinary 5-oxoproline may be useful to identify pyroglutamic acidosis as underlying cause of HAGMA in patients with multiple risk factors. Serious skin reactions such as acute generalized exanthematous pustulosis (AGEP), Stevens - Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN), have been reported very rarely in patients receiving paracetamol. Patients should be informed about the signs of serious skin reactions and use of the drug should be discontinued at the first appearance of skin rash or any other sign of hypersensitivity. Calpol Six Pus Fastmelts: contains aspartame, which is hydrolysed in the gastrointestinal tract when orally ingested. One of the major hydrolysis products is phenylalanine. This medicine is therefore contraindicated in patients with phenylketonuria. This medicine contains 0.00064mg benzyl alcohol in each tablet. High volumes should be used with caution and only if necessary, especially in subjects who are pregnant or breastfeeding, or subjects with liver or kidney impairment because of the risk of accumulation and toxicity (metabolic acidosis). This medicine contains glucose. Patients with rare glucose-galactose malabsorption should not take this medicine. Calpol Six Plus SF-CF Suspension: contains 2.04g Maltitol and 1.4g Sorbitol per 5ml. Sorbitol and maltitol may cause gastrointestinal discomfort and have a mild laxative effect. Patients with hereditary problems of fructose intolerance (HFI) should not take/be given this medicine. Calorific value 2.3kcal/g maltitol. Methyl and propyl parahydroxybenzoates may cause allergic reactions (possibly delayed). Contains less than 1 mmol sodium (23 mg) per 5ml, that is to say essentially ‘sodium-free’. This medicine contains 20.92mg propylene glycol (E1520) in each 5ml dose, which is equivalent to 4.18mg/ml. This medicine contains 0.05mg benzyl alcohol in each tablet. High volumes should be used with caution and only if necessary, especially in subjects who are pregnant or breastfeeding, or subjects with liver or kidney impairment because of the risk of accumulation and toxicity (metabolic acidosis). This medicine contains 0.00075mg of alcohol (ethanol) in each 5ml which is equivalent to 0.00015 mg/ml. The amount in 5 ml is equivalent to less than 1ml beer or 1 ml wine. The small amount of alcohol in this medicine will not have any noticeable effects. Undesirable effects: Blood and lymphatic system disorders: Not known – Agranulocytosis, Haemolytic anaemia, Thrombocytopenic purpura. Immune system disorders: Rare – Hypersensitivity. Not known - Anaphylactic reaction. Hepatobiliary disorders: Not known Hepatic function abnormal, Hepatic necrosis. Skin and subcutaneous tissue disorders: Rare – Rash. Not known - Fixed eruption, Rash pruritic, Urticaria. Renal and urinary disorders: Uncommon - Nephropathy toxic. Not known - Renal papillary necrosis (after prolonged administration). Investigations: Not known - Transaminases increased. Metabolism and nutrition disorders: Not known - High anion gap metabolic acidosis. Liver damage has been reported after daily ingestion of excessive amounts of paracetamol. A review of a group of patients with chronic active hepatitis failed to reveal differences in the abnormalities of liver function in those who were long-term users of paracetamol nor was the control of the disease improved after paracetamol withdrawal. Low level transaminase elevations may occur in some patients taking labelled doses of paracetamol; these elevations are not accompanied with liver failure and usually resolve with continued therapy or discontinuation of paracetamol. Very rare cases of serious skin reactions have been reported. High anion gap metabolic acidosis. Cases of high anion gap metabolic acidosis due to pyroglutamic acidosis have been observed in patients with risk factors using paracetamol. Pyroglutamic acidosis may occur as a consequence of low glutathione levels in these patients. MAH: JNTL Consumer Health I (Ireland) Ltd., Block 5, Hight Street, Tallaght. Dublin 24, Ireland. MA Number: PA 23490/003/003. , PA 23490/003/005. Date of last revision of text: February 2025. Product not subject to medical prescription. Supply through non-pharmacy and pharmacy outlets. Further information available upon request from JNTL Consumer Health I (Ireland) Ltd. 1: Summary of Product Characteristics: Calpol Six Plus Sugar / Colour Free Suspension, Calpol Six Plus Fastmelts 250mg Orodisperable Tablets IE-CAL-2026-333015

Marketing Insight: Ones2Watch

Ones to Watch: The Brands Gaining Momentum in Ireland’s OTC Market Every year, the IQVIA Top 100 rankings provide a valuable snapshot of Ireland's over-the-counter (OTC) medicines market. While much of the attention naturally focuses on the products occupying the very top of the table, the most interesting story often lies elsewhere. Looking beyond the familiar market leaders reveals the brands quietly building momentum, the categories gathering pace, and the changing health needs of Irish consumers. The 2026 IQVIA Top 100 demonstrates remarkable stability at the top of the rankings. Solpadeine retains the number one position, Calcichew D3 remains firmly in second place, while Nurofen Plus continues to occupy third. This consistency reflects the enduring demand for trusted pain management and bone health products, demonstrating that established brands continue to enjoy strong consumer confidence. However, beneath this stable top tier, significant movement is taking place. Several products have climbed dramatically through the rankings, while entirely new brands have entered the Top 100, highlighting evolving consumer behaviours, changing disease prevalence, greater awareness of self-care and increasing pharmacist intervention across a number of therapeutic areas. Digestive Health Emerges as the Standout Growth Story If one category can be described as the success story of this year's rankings, it is digestive health. No fewer than three digestive products feature amongst the biggest risers of the year, while the category itself increases its representation within the Top 100 from 15 products to 17. Perhaps the most impressive performer is Buscopan IBS, which climbs an outstanding 16 places, moving from number 49 to number 33. This is the largest upward movement recorded anywhere in this year's rankings and reflects the growing recognition of irritable bowel syndrome as a condition that patients increasingly seek to manage themselves before consulting their GP. Close behind is Senokot, rising 13 places from 44 to 31. Constipation continues to be a common complaint across all age groups, driven by increasingly sedentary

lifestyles, dietary habits and an ageing population. Pharmacists remain ideally placed to recommend appropriate treatment while offering wider lifestyle advice around fibre intake, hydration and physical activity. Lactulose FRS also records a substantial improvement, climbing from number 24 to number 14. Combined with Senokot's impressive rise, the data suggests that constipation management is becoming an increasingly important component of community pharmacy practice. Meanwhile, Gaviscon continues its own steady upward trajectory, improving from number 12 to number 8. Reflux remains one of the most common conditions presenting in community pharmacy, and the continued growth of Gaviscon reinforces its position as one of the country's most trusted self-care treatments. Adding further weight to the digestive health story are two new entrants. Emazole Control enters the rankings strongly at number 35, while Optibac makes its debut at number 93, reflecting growing consumer interest in probiotics and gut health. Taken together, these movements suggest digestive health is no longer simply a seasonal or reactive category. Instead, it has become a year-round focus for both patients and pharmacists, with increasing public awareness of IBS, reflux, microbiome health and preventative digestive care. Eye Care Continues Its Rapid Rise Another category that continues to gather momentum is eye care. Over recent years dry eye disease has become an increasingly common presentation in pharmacy, fuelled by an ageing population, prolonged digital screen use, contact lens wear

and greater awareness of ocular surface disease. The IQVIA data reflects this trend clearly. Hylo Forte breaks into the Top 10 for the first time, climbing from number 14 to number 9. Thealoz Duo also records an excellent performance, moving up 10 places from 37 to 27, making it one of this year's strongest performers. Perhaps most notably, Hylo Dual appears as an entirely new entrant at number 80, while Hylo Night maintains its position within the rankings. Collectively these products demonstrate that consumers are increasingly seeking specialist eye care products rather than relying solely on traditional artificial tears. For community pharmacists, this represents an important advisory opportunity. As dry eye becomes more prevalent, pharmacists are ideally positioned to differentiate between allergy, dry eye and more serious ocular conditions while recommending appropriate treatment or referral where necessary. Wellness and Prevention Continue to Expand Another notable trend emerging from this year's rankings is the continued evolution of preventative healthcare. While acute illness and pain management remain dominant, consumers are increasingly investing in products designed to support everyday wellbeing. Calcichew D3 continues to hold the number two position nationally, underlining the sustained importance of bone health and vitamin D supplementation. Further down the rankings, several entirely new products reinforce this preventative health trend.

Aya Electrolyte enters the Top 100 at number 79, reflecting increasing awareness around hydration, exercise recovery and illnessrelated dehydration. Optibac, already highlighted within digestive health, represents another example of consumers proactively managing their health through probiotic supplementation. These products reflect a wider shift within pharmacy, where conversations increasingly extend beyond treating illness towards supporting long-term wellness and prevention. Pain Relief Remains the Foundation of OTC Despite the emergence of new growth categories, pain relief continues to dominate the Irish OTC landscape. Four of the top six products remain pain brands, underlining the category's continued importance to both consumers and pharmacies. However, beneath these established leaders there are interesting changes. Rowalief climbs an impressive 15 places from number 69 to number 54, making it the second biggest riser across the entire Top 100. Meanwhile, Paracetamol BF& enters the rankings as a new entrant at number 36, demonstrating that value-led analgesic options continue to attract consumers. Not every pain product enjoyed a positive year, however. Nurofen Express falls 12 places, while Thermacare drops 14 positions. Excedrin also exits the Top 100 altogether. These contrasting performances illustrate just how competitive the pain category has become. While demand remains consistently high, brand preference continues

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27 to evolve as consumers balance efficacy, price, convenience and pharmacist recommendation.

Benylin Chesty falls 20 places, becoming one of the largest movers down the rankings.

Ones to Watch

Skin Health Continues to Diversify

Benylin Dry Night drops 14 places, while Actifed declines by 12 positions.

AYA Electrolytes Plus Celebrates Top 100 OTC Success

Although not attracting the same attention as digestive or eye care, several skin-related products have delivered impressive performances this year. Caldesene rises 13 places to number 63, while Lyclear also improves by 13 places. In addition, Ultrapure enters the rankings at number 87, reflecting continuing consumer interest in barrier repair and skin protection. These products demonstrate how pharmacy's role within dermatology continues to broaden beyond traditional first aid into everyday skin maintenance and preventative care. New Entrants Reflect Changing Consumer Priorities Seven products enter the IQVIA Top 100 for the first time this year. While each has its own story, collectively they paint a clear picture of where consumer demand is heading. The newcomers are concentrated within digestive health, hydration, eye care, skin care and modern pain management rather than traditional cough and cold medicines. This reflects several broader healthcare trends: • Greater consumer confidence in self-care. • Increasing interest in preventative wellbeing. • Growing awareness of gut health. • Rising demand for specialist eye care. • Continued innovation across established OTC categories. Rather than simply replacing older brands, these products demonstrate how pharmacy continues to evolve alongside changing patient expectations. A More Challenging Year for Respiratory Products If digestive health represents the strongest growth story, respiratory medicines experienced a more mixed year. Several established brands recorded notable declines.

The category also loses one product overall compared with last year. However, the picture is far from universally negative. Lemsip remains firmly positioned within the Top 20, demonstrating the enduring strength of trusted seasonal brands. The year-on-year volatility seen across cough and cold products highlights how heavily seasonal factors, viral circulation and consumer purchasing behaviour continue to influence this category. Looking Beyond the Numbers While the annual rankings inevitably celebrate the products sitting at the top of the table, some of the most valuable insights come from studying movement rather than position alone. This year's biggest risers highlight several consistent themes. Consumers are increasingly seeking solutions for long-term chronic conditions such as IBS, constipation and reflux.

We’re delighted to see AYA Electrolytes Plus enter the IQVIA Top 100 OTC Products, as featured in Irish Pharmacy News. This milestone reflects the continued love consumers have for the product’s effective hydration support, energy boost and greattasting flavours. The brand has gone from strength to strength, delivering four consecutive years of double-digit growth, supported by strong partnerships with pharmacies nationwide. From training webinars, FSDUs, window displays and counter trays to in-store tasting kits, we’re committed to helping retailers drive sales. This year’s campaign included a major outdoor advertising initiative featuring Robbie Henshaw on Dublin Bus, Bus Eireann, the 4 main bridges in Dublin and Ireland's maion rail stations, alongside PR, social media and in-store activation. We also enjoyed fantastic engagement attending WellFest, where Cola with Caffeine proved the surprise crowd favourite. If you'd like tasting kits, POS materials or social assets for your store, contact your Uniphar Brand Partners representative.

Dry eye has firmly established itself as a major community pharmacy category. Preventative healthcare continues to expand through vitamins, hydration and probiotic products. Meanwhile, pharmacy is becoming ever more central to supporting self-care, with patients looking to their pharmacist for advice across an increasingly diverse range of everyday health concerns. For manufacturers, these findings provide valuable insight into where future opportunities may lie. For pharmacists, they reinforce the importance of maintaining expertise across emerging categories while continuing to deliver high-quality clinical advice. As Ireland's OTC market continues to evolve, today's fastest risers may well become tomorrow's market leaders. The 2026 IQVIA Top 100 suggests that while trusted household names remain firmly established, the next generation of OTC success stories is already beginning to emerge.

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Marketing Insight: Trends

Emerging OTC Trends Community pharmacy has changed dramatically over the last number of years, and for the better. As one of the most accessible healthcare settings, pharmacies have evolved from simply dispensing prescriptions to becoming an essential part of primary care within our communities. For many people, the pharmacy is now their first stop when they start to feel unwell. This shift has been driven not only by increasing pressure on GP services but also by changing patient expectations. People are taking a much more active role in their own health, with a growing interest in prevention, self-care and overall wellbeing. Written by Carol Byrne

The Rise of the Proactive Patient Today's pharmacy customer is very different from the customer of even ten years ago. With so much health information available online, people often arrive having already researched their symptoms or treatment options. They don't just want to know what to take—they want to understand why they're taking it. Questions about how medicines work, possible side effects and interactions with supplements or existing medications are becoming increasingly common. This reflects a wider shift towards better health literacy. Patients are more confident managing minor ailments themselves, often to avoid the wait for a GP appointment. As a result, pharmacists have become trusted educators as well as healthcare providers. Every day, pharmacy teams provide evidencebased advice, helping patients treat minor conditions safely while recognising when referral to another healthcare professional is needed. We've also seen a significant increase in demand for home diagnostic testing. Whether it's vitamin deficiency testing, inflammatory markers or rapid viral tests, more people want clear

information before deciding on their next steps. These tests give patients greater confidence and provide useful information they can bring to their GP or another healthcare professional if further assessment is required. Prevention Before Treatment Another clear trend is the growing focus on preventative healthcare. Customers aren't just looking for relief from today's symptoms— they're asking how they can improve their long-term health and reduce the likelihood of becoming unwell in the future. This has led to increased demand for products that support immune health, gut health, sleep, stress management and overall wellbeing. More conversations are centred around lifestyle, nutrition and supplementation rather than simply treating illness after it develops. At the same time, convenience remains a major priority. When people do need over-the-counter medication, they often prefer combination products that relieve multiple symptoms at once. Busy lifestyles mean customers value the simplicity of one product that can manage fever, congestion and cough rather than juggling several different medicines throughout the day. The Growth of Supplements and Sports Nutrition One of the biggest changes in recent years has been the

mainstream acceptance of sports nutrition products and health supplements. Products such as protein powders, creatine and vitamins have moved far beyond gym culture and are now part of many people's everyday health routines. Protein powders are no longer just for athletes. Many customers now use them to increase protein intake, support weight management or simply as a convenient meal option when time is limited. Older adults are also becoming more aware of the importance of adequate protein intake to help maintain muscle mass as they age. With so many options available—including whey, plant-based and collagen products—customers increasingly look to pharmacy teams for advice on choosing the most suitable product. Creatine has also seen a significant change in public perception. Once viewed purely as a bodybuilding supplement, it is now recognised for its wider health benefits. Growing research into its role in muscle health, recovery, cognitive function and healthy ageing has led to increased interest from a much broader audience, including older adults and students. Many customers come to the pharmacy looking for reassurance about its safety and whether it is suitable alongside their existing medications or medical conditions. This growing interest in supplements reflects a wider move towards preventative selfcare. Rather than waiting until a deficiency develops, many people are choosing to support their health proactively with products such as magnesium, vitamin D, omega-3 fatty acids and probiotics. Social media has undoubtedly influenced this trend, but it has also highlighted the need for reliable, evidence-based advice. Customers are often faced with conflicting information online, making trusted healthcare professionals more important than ever.

While this is a positive trend, it also highlights the increasingly important role of the pharmacist. Supplements can interact with prescription medicines, duplicate existing treatments or simply be unnecessary. Customers are often influenced by social media and online marketing, making professional guidance more valuable than ever. Pharmacy teams are well placed to separate evidence from misinformation, explain the science behind popular products and help patients make informed decisions based on their individual health needs and goals. The Future of Community Pharmacy Community pharmacy will continue to play an increasingly important role within the healthcare system. As patients become more informed and proactive, pharmacies are ideally positioned to provide accessible advice, early intervention and ongoing support for preventative health. The challenge moving forward is to balance the demand for convenient healthcare solutions with safe, personalised clinical care. Pharmacy is no longer simply a place to collect prescriptions—it has become a trusted destination for health advice, preventative care and evidence-based guidance. Looking ahead, the pharmacies that thrive will be those that continue to adapt to changing patient expectations while maintaining the personal relationships that have always been at the heart of community pharmacy. Technology, diagnostic services and expanded clinical roles will all shape the future, but the value of face-to-face conversations and trusted professional advice will remain irreplaceable. By continuing to educate patients, support informed decision-making and promote safe self-care, pharmacists are helping shape a healthcare system that is more accessible, proactive and focused on long-term wellbeing.

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Call for papers: make your contribution to Irish Pharmacy News  Articles  Research Papers  Reviews  Programme Descriptions  Reports Case Reports  Letters to editor  In-depth review articles critique fundamental concepts, issues, and problems that define a field of research or practice and support advanced practitioners as well as aspiring early-year pharmacists.  Practice reports share innovations on any area of practice, including delivering clinical services, pharmacy administration, or new approaches to inform and engage with patients with the aim to improving pharmacy practice.  Perspective articles focus on a specific field or discipline and discuss current advances or future directions, and may include original data as well as expert insight and opinions.

Contact: Kelly Jo Eastwood at: kelly-jo@ipn.ie or Anna Hadfield anna@ipn.ie

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Marketing Insight: OTC Purchasing

The Pharmacist’s Influence on OTC Purchasing Community pharmacy has changed dramatically over the last number of years, and for the better. As one of the most accessible healthcare settings, pharmacies have evolved from simply dispensing prescriptions to becoming an essential part of primary care within our communities. For many people, the pharmacy is now their first stop when they start to feel unwell. This shift has been driven not only by increasing pressure on GP services but also by changing patient expectations. People are taking a much more active role in their own health, with a growing interest in prevention, self-care and overall wellbeing. Written by Juan Del Alamo, Pharmacist and Owner of Remedi CarePlus Pharmacy; Stephen Conlan, Dispensary Manager and Pharmacy Technician; and Fiona Cannon, Pharmacist

OTC medicines. That trust is not given lightly, nor taken for granted. It has been earned through decades of pharmacists being visible, approachable and reliable members of their communities. When a patient asks for my recommendation, they are asking me to apply years of training to their situation and tell them, honestly, what is right for them. This is a privilege that comes with responsibility. Confidence in the face of choice The modern pharmacy shelf can be overwhelming. For most common ailments there are now several competing brands, many with very similar active ingredients but different packaging, formats and price points. For a patient who is unwell, tired and unsure, that choice can be paralysing rather than empowering.

Long before a prescription is dispensed or a medicine recommended, treatment often begins with a conversation. This patient-centred approach reflects Sir William Osler’s observation that, “The good physician treats the disease; the great physician treats the patient who has the disease.” Community pharmacists embody this every day, serving not only as medicine experts but as accessible professionals who understand the individual behind the condition. Walk into any community pharmacy on a busy afternoon and you’ll see a familiar scene: someone approaches the counter, a little unsure, and describes what has brought them in. A cough that won’t shift, a child with hay fever, aching joints, a cold settled on the chest. They cannot simply pick up a box from the shelf and compare options, as the medicines they

need are kept behind the counter, with us. Instead, they ask, “Which one should I actually get?” It’s a question I hear many times each day. That moment, small as it seems, sits at the heart of my work, where clinical knowledge, trust and everyday decision-making meet. Because these products sit behind the counter, almost every purchase begins with a conversation, and that is precisely why the influence a pharmacist and their team have on over the counter (OTC) purchasing is one of the most underappreciated forces in public health. Trusted advice Year after year, surveys confirm what those of us behind the counter already know: pharmacists are consistently rated among the most trusted healthcare professionals for recommending

This is where professional advice changes everything. When I explain why a product suits someone’s symptoms, I am helping them make an informed decision, why an ibuprofen-based treatment might suit their inflammation better than paracetamol, or why a non-drowsy antihistamine makes more sense when they need to drive to work. The patient leaves knowing they have chosen the most appropriate product for their symptoms, not the one with the loudest advertising. People who understand why they are taking something use it correctly, persist with it when appropriate, and recognise when it is not working. Good advice at the point of purchase improves outcomes long after the patient has left the store. Clinical need before promotion or price One principle I return to constantly, in my own practice and when training my team, is this: recommendations must always

be based on clinical need, safety and effectiveness. The temptation to favour whatever is on offer, or carries the best margin, exists in every retail environment. However, the pharmacy is not an ordinary retail environment. My job is to recommend the right treatment for the person in front of me. That can be a well-known brand, a cheaper generic with an identical active ingredient, or sometimes the right answer is that they don’t need a product at all. Being willing to say so reflects our PSI core principles of professionalism, honesty and putting patient welfare first. Asking the right questions Safe recommendation begins with the right questions. Is the treatment for themselves or someone else? How long have the symptoms lasted? Are they taking other medicines? Do they have any conditions, allergies or a pregnancy that would make a product unsuitable? The WWHAM technique is taught to every OTC staff member on their first day, but through experience we adapt this structured approach into something more conversational, engaging with each patient as an individual. These questions are not a formality; they are the foundation of safe supply. A medicine appropriate for one person may be unsafe for another, and the only way to tell is to ask. A good consultation, even one lasting a minute or two, is often the most important thing that happens in any OTC transaction. The team behind the counter While much of the focus falls on pharmacists, patient trust is built by the whole team. The counter assistants and technicians who greet patients, ask the initial questions and know when to involve the pharmacist are every bit as important; their knowledge, training and consistency turn a one-off interaction into a lasting

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31 relationship. A friendly smile, a listening ear and a positive experience can change a person’s entire day. Ongoing education here is essential. In our case, Navi Group supports the team through regular training. Their bi-monthly sessions for front-of-shop staff give practical guidance across cough and cold, allergy, eye health, women’s health and paediatric care. Training keeps the team’s knowledge current and improves our ability to identify appropriate complementary treatments. When a patient receives sound advice every visit, regardless of who is on duty, they learn they can rely on the pharmacy as a whole. Loyalty built on good experiences I have lost count of the customers who returned specifically because of a recommendation that genuinely helped them. Someone comes in with a persistent cough, we advise the right treatment, it works, and from then on, they think of us first whenever they or their family are unwell. Such experiences build loyalty, encourage repeat visits and prompt patients to seek advice earlier. Word spreads locally, too: people recommend “asking

the pharmacist first” rather than going straight to their GP. That is valuable not only for the pharmacy but for public health. A patient who feels comfortable asking for advice is one we can help sooner, more safely and more effectively. Healthcare without an appointment Community pharmacies are often the most frequently accessed healthcare setting, and that accessibility is one of our greatest strengths: long hours and no appointment needed. With everincreasing pressure on clinics, many people cannot easily access a GP, whether because of cost, long waitlists, or uncertainty over whether their symptoms warrant a visit. The pharmacy is often the first, and sometimes the only, point of contact with a healthcare professional. This easy access takes pressure off the wider health system, but more importantly it means people can get trusted advice the moment they need it. For many, we are the gateway to healthcare. Knowing when to refer Recommending products is only half our role; we must also recognise when a patient needs more than we can safely offer

over the counter and refer them onward. Knowing the limitations of pharmacy is central to patientcentred care. A headache is usually just a headache, but occasionally a warning sign; a stomach complaint is often minor but sometimes points to something needing urgent attention. Having the confidence to say “this needs to be seen by a doctor” is one of the most valuable things a pharmacy team does. Good OTC advice is not about selling something in every interaction; it is about doing the right thing for the patient, even when that means sending them elsewhere. Digital tools and joined-up care The pharmacy of today does not work in isolation. Symptom checkers, patient records, blood pressure monitoring and other point-of-care services increasingly complement traditional practice. Used well, technology does not replace the human consultation, it strengthens it. Recognition and what it means Our philosophy was recognised when we received the Haleon Self-Care Award at the Irish Pharmacy Awards 2026, acknowledging our team’s

commitment to responsible, high-quality, patient-centred care. More than the recognition itself, it reinforced our core belief: that trusted pharmacist advice is central to helping patients make informed OTC purchasing decisions. Awards are lovely, but the real reward is knowing people leave our pharmacy better informed and better cared for than when they arrived. Looking ahead The future of community pharmacy lies in combining clinical expertise with genuine, personalised advice. As our clinical role grows, with pharmacist prescribing and an expanding range of services, we will become an even more influential part of patients’ healthcare journeys. The OTC consultation is just the beginning: a chance to identify unmet needs, intervene earlier and direct patients towards the most appropriate care. In an increasingly complex healthcare landscape, patients still seek something remarkably simple: someone they trust to guide them. As Francis Peabody observed, “The secret of the care of the patient is in caring for the patient.” That, ultimately, is what community pharmacy has always been about.

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Marketing Insight: Ageing Consumer

Ireland’s Ageing Population Consumers Written by Catriona Brennan, Candidate Advanced Nurse Practitioner Frailty; Paula Murphy Senior Pharmacist Frailty, Midlands Regional Hospital Portlaoise

Ireland’s population is aging rapidly, with more than 1 million people expected to be over 65 by 2057. This looming demographic shift means the HSE will have to evolve quickly to look after the most vulnerable.

Source: John Hartford Foundation

Source: John Hartford Foundation Teams in acute hospitals to

Catriona Brennan

Paula Murphy

The trend is not unique to Ireland. Across the EU, people over 65 accounted for 21.6% of the population in January 2021, as the population pyramid below demonstrates.

faces longer waits for primary and secondary care, beds and diagnostics, alongside frequent A&E overcrowding.

improve coordination with community teams. The goal is to help older people live happy, independent lives in their own homes and communities for as long as possible.

People living with frailty are far more likely to experience anxiety and clini and their relatives or carers are more likely to experience carer burden an are you can think of at least one patient right now in your pharmacy who f These HSE teams are typically After 15 years in community multidisciplinary, often including description. pharmacy and a role change two

pharmacist participation, and are years ago, I have been struck by designed to rapidly assess older how differently the same patient pressure on Irish healthcare and is cared for across Written by Catriona Brennan, Candidate Advancedpopulation Nurse Practitioner Frailty; Paula Murphy adults over 75 at the hospital “front social supports. Ireland is generally door”—A&E. Seniorconsidered Pharmacist Frailty, Hospital Portlaoise the system. a goodMidlands countryRegional in which to grow old. However, the The teams operate under A Shift Toward Communityworker-to-retiree ratio, currently the HSE’s National Clinical Based Care around 5:1, is expected to fall Programme for Older People, substantially, shrinking the tax Sláintecare’s “ageing in place” working to avoid unnecessary Ireland’s rapidly, and more than 1 million people are expected to be basepopulation available istoageing fund public strategy aims to shift care from admissions and reduce length over 65 by 2057. This looming demographic shift means our health systems will have to services and healthcare. crisis-driven hospital stays towards of stay. When a patient is evolve quickly to look after our most vulnerable citizens. proactive community supports. identified as frail, their care People over 65 already account for The trend is not unique to Ireland. Across the EU, people over 65 accounted for more thanneeds are established, with most acute and long-term hospital Sláintecare’s Enhanced one-fifth (21.6%) of the total population as of January 2021.The population pyramid belowearlier signposting toward bed occupancy. As the over-85 Community Care programme compares the EU’s age structure in 2019 with projections for 2050, and the shape tells its the appropriate pathway, population grows, the system established Frailty Intervention advance healthcare planning, or own story—the base narrows while the upper bands swell. referral to MDT and outpatient services. Patients may also be referred to advanced nurse practitioners specialising in Parkinson’s disease, dementia, or older people’s services, or to geriatrician-led regional ICPOP teams. It is well worth a community pharmacist’s time to become familiar with these pathways, since patients or their families often have had extensive conversations about their concerns long before a crisis brings them to hospital. ThisAgeing shift isPopulation placing growing Ireland’s Consumers

increased vulnerability to adverse health outcomes”—a distinctive state related to ageing in which the body loses its inbuilt reserves, affecting a person’s ability to recover from periods of ill health. People are living longer, often with multiple long-term conditions, and frailty frequently accompanies that longevity. The impact of frailty is stark.

Many with frailty also Frailty does not mean a person lacks capacity or ispeople incapable of have living a fu cognitive impairment or dementia, life. It may simply mean that they, their carers,and and families vicetheir versa. Older people need to with frailty often experience five changes, and accept help so the person can become the best version of t common syndromes: People living withhealth frailty are condition far Someone living with frailty may have no other diagnosed more likely to experience anxiety easily fall through the cracks and remain unknown to health and clinical depression,professional and their relatives or carers are more likely unfolds. to experience carer burden and

Spotting the Early Signs

strain. Chances are you can think of at least one patient right now in your pharmacy who fits this description.

Frailty not meanincreasing a person Community pharmacists may be among the first todoes identify fra lacks capacity or is incapable of living a full, independent life. It You may notice that your patient has:

● ● ● ●

may simply mean that they, their carers, and their families need to adapt, make changes, and accept help so the person can become the best version of themselves. Someone living with frailty may have no other diagnosed health conditions, so they can easily fall through the cracks and remain unknown to health professionals until a crisis unfolds.

A change in gait or movement—unsteadiness, or holding onto surf Sudden or unintentional weight loss Muscle weakness Excessive fatigue, feeling constantly tired, or an uncharacteristic l to complete everyday tasks Defining Frailty Spotting the Early Signs ● A marked reduction in movement, or withdrawal from places, hob The British Geriatrics Society Community pharmacists may they once enjoyed describes Frailty as “a longbe among the first to identify term health condition reflecting

increasing frailty in a patient.

For example, a patient who previously visited the pharmacy regularly mig request home delivery of their medication, or seem withdrawn without an Think pHsocial, balance in their material, or medicaltoo. circumstances.

This shift is placing growing pressure on Irish healthcare and societal supports. Ireland is generally considered a good country to grow old in, and our older residents are largely well provided for. However, our traditional worker-to-retiree ratio—currently around 5:1—is expected to drop substantially in the coming decades, shrinking the tax base available to fund public services and healthcare.

People over 65 already account for a majority of hospital bedBV occupancies, both acuteisand Our Treatment a non-drug-based long-term. With the growing cohort of over-85s, the system faces prolonged wait times for

These conversations can be difficult or upsetting for patients and their fa formula which is clinically proven to provide to remember most trust their pharmacists and pharmacy te effectivethat relief frompatients BV symptoms.

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Marketing Insight: Ageing Consumer Analgesia: Acute pain is common in older people but tends to be under-recognised and undertreated which subsequently can lengthen hospital stays and reduce quality of life. OTC analgesics are generally well tolerated and effective when taken at recommended doses. The British Geriatrics Society recommends a “start low, titrate slow” approach in frail older adults. This favours a multimodal, low-dose strategy—for example, regular paracetamol or topical agents.

Changes you might notice include: • A change in gait or movement— unsteadiness, or holding onto surfaces for support • Sudden or unintentional weight loss • Muscle weakness • Excessive fatigue, feeling constantly tired, or an uncharacteristic lack of motivation to complete everyday tasks • A marked reduction in movement, or withdrawal from places, hobbies, or interests they once enjoyed For example, a patient who previously visited the pharmacy regularly might unexpectedly request home delivery of their medication, or seem withdrawn without any obvious change in their material, social, or medical circumstances. These conversations can be difficult or upsetting for patients and their families, but it helps to remember that most patients trust their pharmacists and pharmacy teams. Openly addressing a patient’s challenges can be a good starting point for them to seek further help, in the community or through their GP. If loneliness or social isolation seems apparent— especially following trauma, illness, or bereavement—a social prescriber is now appointed in many HSE regions. Social prescribing connects people to activities, groups, and services that meet the practical, social, and emotional needs affecting their wellbeing, with referrals from GPs, any healthcare professional, or the patient themselves. Practical Interventions for Community Pharmacists Community pharmacists have an important role to play in identifying frailty and delivering interventions that optimise medicines use for frail older adults. Much of this happens on an ad-hoc basis, since resolving medicines-related issues through collaboration with prescribers is already a large part of the role. In Ireland, the TILDA study has extensive information about lifestyle choices, behaviours, and strategies that can help support people through the ageing process. Ireland has also begun adopting the Age-Friendly Health System’s 4Ms framework, which distils global evidence on good

Source: Terry Fulmer 2022

care for older people into four essential domains: Community pharmacists sit front and centre of the “Medication” domain, ensuring medication use is age-friendly, actively reconciling what patients take to prevent harmful interactions, and flagging potential medication optimisation opportunities to prescribers when appropriate. Bone protection and osteoporosis risk: Many patients presenting to hospital show non-compliance with, or a lack of understanding of, how and why they should be taking medication to protect their bones. Correct counselling on bisphosphonate use—including how and when to take it—is genuinely useful, and a soluble calcium formulation may suit patients who struggle to swallow tablets. If a patient is not collecting their preventative medications, it is worth asking why; equally, some remain on these supplements beyond the appropriate time. Malnutrition and dehydration: Malnutrition affects around 1 in 10 older people and is a recognised risk factor for frailty. Patients can be counselled on the correct use of supplements and options to improve the palatability of oral nutritional supplements (ONS). Dehydration is widespread among older people, frequently leads to hospital admission, and is linked to a higher risk of UTIs, falls, and pressure ulcers. Encourage fluid intake where appropriate;

rehydration options such as ORS® and Phizz® are now widely available OTC and may also help. Bladder and bowel health: Incontinence is common in older people, and stigma often means they delay seeking help. Symptoms are frequently poorly managed and can lead to social withdrawal. Advise caution where incontinence medications are prescribed, as many carry a high anticholinergic burden, especially in combination with other anticholinergic agents. Constipation is a surprisingly common and often overlooked trigger for acute confusion or delirium. Ask how patients are actually using their Macrogol or Lactulose—many take it only in response to symptoms, missing out on the benefit of regular osmotic laxative use, Others may need a stimulant laxative such as OTC senna, particularly where diuretic use is limiting an osmotic agent’s effect. Prune juice/ kiwis remain a good low-tech option, and it is worth checking that patients on opioids are also taking regular laxatives to avoid opioidinduced constipation. Falls: Falls and fractures are a leading cause of older people losing their independence and moving into long-term care. After a fall, fear of falling can drive further inactivity, loss of strength and confidence. Assist patients in identifying potential Falls Risk Increasing Drugs (FRIDs) and discussing alternatives with their GP.

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Regular paracetamol, available in soluble or film-coated forms, remains the “gold standard” analgesic for older adults, but a maximum daily dose of 2–3 g is recommended for patients who are frail, weigh less than 50 kg, or have severe liver or kidney impairment. Topical NSAIDs, such as ibuprofen or diclofenac, are useful where oral NSAIDs are not appropriate which may carry a high risk of adverse events in frail older patients, including GI bleeding, acute kidney injury, and cardiovascular complications. Where necessary, use short-acting agents such as ibuprofen at the lowest effective dose for the shortest duration, ideally alongside a gastro-protective agent such as a PPI, now widely available over the counter. Vitamin supplementation in frail older adults: The NHS recommends that patients consult a pharmacist or doctor before starting a general multivitamin, since some supplements can interfere with medications or cause adverse effects. Pharmacists are ideally placed to make these recommendations; they know their patients! For those with swallow issues, liquid formulations such as Vivioptal® or Pharmaton® may be worth exploring. It is beyond the scope of this article to cover every opportunity for community pharmacies to enhance the quality of life of a frail older person—this is simply a starting point, and a wealth of further resources is available online for anyone who wants to explore the topic further. The final word goes to the renowned American surgeon Atul Gawande, who, in his 2014 book Being Mortal, writes that “the ultimate goal is not a good death but a good life—all the way to the very end.”

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Marketing Insight: Eye Care

Every Red Eye is an Opportunity How community pharmacy is becoming the first stop for eye care in Ireland Eye care is quietly becoming one of pharmacy'sbiggest clinical opportunities

A painful red eye in a contact lens wearer should always ring alarm bells.

Most pharmacies see eye complaints every single day.

Think corneal ulcer. Think microbial keratitis. Think same-day referral. Never simply assume conjunctivitis.

Some are straightforward. Others can threaten sight within hours. The challenge is that many patients don't know the difference.

It was 4.45pm on a wet Saturday afternoon. The surgery had closed hours earlier. The local optician was shut. There were still people waiting forvaccinations, a queue at the medicines counter and the phone hadn't stopped ringing all afternoon.

"My eye's red." As pharmacists and pharmacy teams, we have to look beyond the redness. We have to understand what is causing it.

His grandmother explained he had woken with a slightly watery eye but throughout the day it hadbecome increasingly sticky.

Fortunately, most presentations follow familiar patterns. The majority fall into a handful of conditions:  Dry eye disease  Allergic conjunctivitis  Infective conjunctivitis  Blepharitis  Styes  Minor eye irritation

A grandmother arrived with her sixyear-old grandson. "I know you're probably closing soon," she said, "but his eye was fine this morning and now it's all stucktogether."

The trick is recognising the patient who doesn't fit those patterns.

If you've worked in community pharmacy for any length of time, you'll recognise that scenarioimmediately.

Whenever someone presents with an eye complaint, I always start with three simple questions.

Twenty years ago, our role might simply have been to recommend an eye wash or suggest seeing theGP on Monday morning. Today, thanks to the Common Conditions Service (CCS), that conversation iscompletely different.

Irritation and grittiness are common. True pain is different. Pain should immediately make you think beyond simple conjunctivitis.

Community pharmacists are increasingly becoming the first healthcare professional patients choosewhen something isn't right with their eyes. That's a huge opportunity—but it also brings greater responsibility. The skill is no longer simply knowing which eye drop sits on which shelf. The skill is knowing when to treat, when to reassure and when to refer.

A Saturday afternoon I'll always remember The young boy sitting in our consultation room had one eye that was red, sticky and producing a yellowdischarge.

To them it's simply…

By Mark McPhillips, Superintendent Pharmacist, Mark's Pharmacy

We also discussed simple but important infection control measures:

The three questions that change everything

Wash hands frequently. Don't share towels. Clean discharge gently with cooled boiled water. Avoid rubbing the eyes. Stay away from contact lenses until fully recovered. Sometimes the advice is just as important as the medicine. The story didn't end there. The following week, his grandmother returned for her ear microsuction appointment.

While chatting afterwards she smiled and said, "I just wanted to say thank you. His eye cleared Importantly, he wasn't in pain. up brilliantly. My daughter vision was normal. 3.His Do you wear contact lenses?couldn't believe the pharmacy He wasn't sensitive to light. sorted everything on a Saturday. We've actuallyOTC moved all our This single question has probably prevented more inappropriate recommendations than any oth There had been no trauma and he prescriptions over here now." didn't wear contact lenses. A painful red eye in a contact lens wearer shouldThat always ring alarm bells. conversation has stayed After completing the assessment with me. Not because we gained and confirming he met the Think corneal ulcer. another family as patients. criteria for the Common But because it reminded me ConditionsService, we diagnosed that every consultation is an Think microbial keratitis. bacterial conjunctivitis. opportunity to demonstrate what moderncommunity pharmacy The same-day family were relieved. Think referral. can do. They had expected to spend hours Never simply assume conjunctivitis. Clinical care builds trust. trying to find an out-of-hours GP. Trust builds relationships. Instead, within one consultation Relationships build better they received advice, appropriate and reassurance. Atreatment simple way to assesshealthcare. the red eye A simple way to assess the red eye RED EYE

1. Is it painful?

│ ┌────────────┴────────────┐ │ Pain or reduced vision? │ URGENT REFERRAL

│ Does it itch? │

2. Has your vision changed?

┌──────────────┴─────────────┐

Blurred vision. Double vision. Flashing lights. Halos. Loss of vision. These are never normal and require urgent assessment.

│

Yes

│ Allergic conjunctivitis

│ Sticky discharge? │ ┌─────────────┴─────────────┐ │ Yes

│ No

│

3. Do you wear contact lenses? This single question has probably prevented more inappropriate OTC recommendations than any other.

│ No

Infective conjunctivitis

│ Dry eye /

blepharitis / (consider CCS)

irritation

Sometimes keeping things simple is the safest approach. Sometimes keeping things simple is the safest approach.

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A Saturday afternoon I'll always remember

The young boy sitting in our consultation room had one eye that was red, sticky and producing a yello discharge.

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1 drop of Thealoz® Duo lasts for up to 4 hours1

DRY EYE The increase in TFT with Thealoz® Duo was significantly eatment of mild DROPnon-infectious allergic or inflammatory conjunctival diseases. Posology: The recommended dosa longer than with HA (p<0,01). With Thealoz® Duo the effect remained over 240 min.in order to avoid of 14 days. Gradual tapering off up to one administration every other day statistically may be significant recommended bstance or to any of the excipients; Known glucocorticosteroid-induced ocular hypertension and other forms of oc pt when combined with specific chemiotherapeutic agents for herpes virus), conjunctivitis with ulcerative keratitis years Products Educating vitis and purulent blepharitis, stye 150 and herpes may be masked or aggravated by anti-inflammatory that are 100% of knowledge & infection that & empowering preservative free expertise in eye care professionals glucocorticoids are excreted in breast milk and may cause suppression of growth or of endogenous corticosteroid ourstinging. eyes Cort fants cannot be excluded. Undesirable effects: Hydrocortisone: Eye disorders: Not let’s known:open Burning, ticosteroids. Eye disorders: Not known: Allergic and hypersensitivity reactions, delayed wound healing, posterior uveitis, changes in corneal thickness, crystalline keratopathy, blurred vision. Cases of corneal calcification have b 2

Reference: 1. Schmidl D1, Schmetterer L et al. Tear film thickness after treatment with artificial tears in patients with moderate dry eye disease. Cornea. 2015 Apr;34(4):421-6. 2: 8. 2. IQVIA Consumer Health Customized Insights for the period 2024, volume and value sales in Euros PUB, limited to IQVIA CHC3 07A3 Artificial Tears and Ocular Lubricants, reflecting estimates of real-world activity in these countries: Austria, Belgium, Bulgaria, Croatia, Czech Republic, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Norway, Poland, Portugal, Romania, Russia, Saudi Arabia, Serbia, Slovakia, Slovenia, South Africa, Spain, Sweden, Switzerland, UAE (United Arab Emirates), UK. Copyright IQVIA. All rights reserved. TP25015

Marketing Insight: Eye Care

Dry eye – the condition that's growing fasterthan we realise If bacterial conjunctivitis is one of the most satisfying consultations, dry eye is probably the mostcommon. Screen time. Air conditioning. Contact lenses. Menopause. Increasing age. Antidepressants. Antihistamines. Beta-blockers. Diuretics. These all contribute. Many patients simply ask, "Can I have some eye drops?" The temptation is to point towards the lubricants. Instead, spend another minute understanding why.

 Watering  Both eyes affected  Seasonal symptoms  Associated hay fever If someone says, "My eyes are incredibly itchy." Think allergy first. If they say,

Warm compresses.

Infective conjunctivitis

Daily lid hygiene.

The Common Conditions Service has transformed how we manage uncomplicated bacterialconjunctivitis.

Patience.

Instead of directing patients elsewhere, eligible patients can now receive assessment and treatment inthe pharmacy.

The red flags we should never miss

This doesn't replace clinical judgement.

Is it worse first thing in the morning? Is it worse in the evening?

 How long has it been present?

Do they spend eight hours looking at screens?

 One eye or both?

Are symptoms affecting both eyes?

 Any visual disturbance?

Small questions often lead to better recommendations.

 Any photophobia?

Clinical Pearl Remind patients using screens about the

 Any pain?

 Any trauma?  Contact lenses?  Previous episodes? These questions take less than two minutes but often determine whether the patient stays in yourconsultation room or needs urgent referral. Don't forget the medicines

20-20-20 rule.

One area that is often overlooked is medication-induced dry eye.

Every 20 minutes…

Patients taking:

Look 20 feet away…

 SSRIs

For 20 seconds.

 Antihistamines

Sometimes the simplest advice makes the biggest difference.

 Beta-blockers

Allergic conjunctivitis Summer is one of the busiest times for allergic eye disease. Patients usually describe:  Intense itching

A CLEAR VOICE WHEN YOU NEED IT MOST.

Patients often expect a drop that fixes everything.

Think again.

Always ask:

Preservatives can worsen ocular surface irritation with frequent use.

Blepharitis can be frustrating for both patients and pharmacy teams.

In reality, success comes from routine.

It enhances it.

If a patient needs lubricant drops more than four times daily, consider recommending a preservative-free preparation.

Blepharitis – think long term, not quick fixes

"They're painful."

How often are the symptoms occurring?

Clinical Pearl

Helping patients understand why symptoms occur often improves adherence to both their eye treatment and their long-term medicines.

 Diuretics  Isotretinoin may all develop ocular dryness. Sometimes changing expectations is as valuable as changing treatment.

Setting realistic expectations early avoids disappointment later.

One of the most valuable roles of community pharmacy isn't prescribing. It's recognising the patient who shouldn't be treated in the pharmacy. Never ignore:  Moderate or severe eye pain  Sudden reduction in vision  Photophobia  Halos around lights  Chemical injuries  Eye trauma  Contact lens wear with a painful red eye  Suspected penetrating injury  Marked unilateral redness with severe pain  Children under four weeks with conjunctivitis When something doesn't feel right, trust your clinical instincts. Patients rarely criticise a careful referral. Five things every pharmacy team can do nextweek 1. Teach everyone the three screening questions.

their pharmacist can assess and prescribe for eligible eye conditions. 4. Stock your eye care category intelligently. Quality advice will always outperform a large range of products. 5. Use every consultation to educate. Demonstrating eye drop technique, discussing contact lens hygiene or reminding diabetic patientsabout regular retinal screening adds real value. Community pharmacy's role has changed Eye care is no longer just another OTC category. It has become another example of how community pharmacy is evolving from a place that suppliesmedicines to a place that delivers clinical care. The Common Conditions Service has accelerated that change. Every red eye now presents an opportunity to assess, diagnose within our scope, prescribe whenappropriate, reassure, educate and recognise when urgent referral could protect someone's sight. The grandmother who came into our pharmacy that Saturday afternoon didn't just leave with treatmentfor her grandson. She left with confidence in her local pharmacy. A week later she trusted us with her own ear care. Soon afterwards, her family trusted us with their prescriptions. That wasn't because we sold an eye drop.

Reception staff and OTC colleagues are often the first people patients speak to.

It was because we delivered accessible, evidence-based, patient-centred care when they needed it most.

2. Build relationships with local optometrists.

Perhaps that's the biggest lesson of all.

Knowing who to call makes urgent referrals smoother.

Every red eye is an opportunity— not just to improve someone's vision, but to strengthen therelationship between community pharmacy and the communities we serve.

3. Promote the Common Conditions Service. Many patients still don't realise

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REFERENCES: 1. Müller-Lierheim, W. G. K. (2020). Why Chain Length of Hyaluronan in Eye Drops Matters. Diagnostics, 10(8), 511. 2. Semp, D., Dutta, D. and Wolffsohn, J.S., 2023. The clinical efficacy of higher molecular weight sodium hyaluronate in artificial tears: A randomised clinical trial. Investigative Ophthalmology & Visual Science, 64(8), pp.3970-3970. 3. Instructions for use, Hylo Forte eye drops, 0.2% Sodium Hyaluronate.

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Marketing Insight: Self-Care

Self-Care and the Evolving Role of Community Pharmacy Over the course of my career, I have seen the role of community pharmacy evolve significantly. While dispensing medicines remains at the heart of what we do, pharmacists are increasingly helping patients manage their own health, prevent illness and access care closer to home. Much of this can be described through one increasingly important concept — self-care. Written by Denis O'Driscoll, Superintendent Pharmacist, McCabes Pharmacy a more active role in managing their health, but they also want access to trusted healthcare professionals who can guide them when needed. Community pharmacists are uniquely placed to provide that support. [selfcare.fip. org], [pharmanewsonline.com] Building Health Literacy One of the things I value most about community pharmacy is the opportunity to educate and empower patients. Every interaction, no matter how brief, has the potential to improve understanding and encourage healthier behaviours.

Self-care is often associated with healthy lifestyles, wellness initiatives or over-the-counter medicines, but for pharmacists it means much more than that. At its core, self-care is about empowering people to understand their health, make informed decisions and access the right support at the right time. Community pharmacists have always played an important role in supporting self-care. Every day, we help patients manage minor ailments, understand their medicines and gain confidence in managing their health conditions. Increasingly, we are also supporting people to prevent illness, identify health concerns earlier and take a more proactive approach to their wellbeing. One of the most rewarding aspects of community pharmacy is seeing patients become more confident in managing their own health. Often, a simple conversation can give someone the knowledge and reassurance they need to make informed decisions about their treatment, while also helping them

understand when further medical advice may be required. As healthcare continues to evolve, self-care is becoming not only desirable but essential. An ageing population, increasing rates of chronic disease and growing pressure on primary care services mean patients need support to take a more active role in managing their health. Community pharmacy is uniquely positioned to help make that possible. Importantly, self-care should never be viewed as patients managing alone. In my view, the most successful self-care occurs when informed patients and trusted healthcare professionals work together to achieve better health outcomes. What we see every day in community pharmacy is reflected in work undertaken by the International Pharmaceutical Federation (FIP), which recognises pharmacists as key enablers of safe and effective self-care. Patients increasingly want to take

Across McCabes Pharmacy, our pharmacists and pharmacy teams support self-care through thousands of patient interactions every week. These conversations may relate to a new medicine, a long-term health condition, a vaccination, smoking cessation, weight management or advice for a common ailment. While each interaction is different, the goal is always the same: helping patients make informed decisions about their health and providing reassurance that trusted professional advice is available when they need it. Supporting self-care goes hand in hand with improving health literacy. Every day, pharmacists help patients better understand their medicines, treatment options and health conditions through accessible, evidence-based advice. Whether explaining how a medicine should be taken, discussing potential side effects, supporting adherence or providing guidance on lifestyle changes, these interactions help patients develop the knowledge and confidence needed to play a more active role in their own healthcare. Often, a few minutes spent with a patient can make a significant difference. A patient presenting with seasonal allergies may leave not only with an appropriate

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treatment recommendation but also with advice on avoiding triggers, recognising worsening symptoms and knowing when further medical review may be required. Similarly, a patient collecting medication for hypertension may receive advice on diet, exercise and other lifestyle measures that work alongside medicines to improve long-term outcomes. Patients who understand their conditions and treatment plans are generally more confident, more engaged and better equipped to manage their health. Community pharmacists are ideally placed to provide that support in a way that is accessible, practical and personalised. Accessibility Matters One of the greatest strengths of community pharmacy is accessibility. Patients do not need an appointment to speak with a pharmacist. They can access healthcare advice quickly, often at the point when they first notice symptoms or have concerns about their medicines. As demand for GP appointments and other healthcare services continues to grow, this accessibility becomes increasingly important. While pharmacists do not replace other healthcare professionals, we can often provide timely advice, reassurance and treatment for common conditions, ensuring patients receive the most appropriate level of care while helping to reduce unnecessary pressure elsewhere in the healthcare system. Equally important is recognising when self-care is not appropriate. A key part of a pharmacist's role is identifying when symptoms require further investigation or referral. Every day, pharmacists use their clinical knowledge to assess symptoms, identify potential medicine-related issues and ensure patients receive the right care at the right time.

41 Supporting self-care therefore involves understanding both what can safely be managed within the pharmacy and when referral is the safest and most appropriate course of action. Prevention and Early Intervention One of the biggest changes I have witnessed in community pharmacy over recent years has been the growing emphasis on prevention and early intervention. Dispensing medicines remains a core part of our profession, but pharmacists are now delivering a much broader range of healthcare services. Vaccinations, blood pressure monitoring, smoking cessation services, weight management support and medicines reviews have become increasingly important elements of modern pharmacy practice. These services improve access to healthcare while creating opportunities to identify health concerns earlier. A routine blood pressure check may identify previously undiagnosed hypertension. A medicines review may highlight adherence challenges or side effects. A smoking cessation consultation may reduce an individual's future cardiovascular risk. While these interventions may appear small individually, collectively they represent a significant contribution to public health and preventative care. Supporting Patients with Chronic Conditions The prevalence of chronic disease continues to increase across Ireland. Conditions such as hypertension, diabetes, asthma and cardiovascular disease require ongoing management, often over many years. Medicines play an important role, but successful disease management depends on much more than prescribing. It relies on patient understanding, adherence, lifestyle modification and regular engagement with healthcare professionals. Community pharmacists are well positioned to support all of these areas. Through regular interactions with patients collecting repeat prescriptions, pharmacists can reinforce treatment goals, discuss concerns, identify barriers to adherence and encourage positive lifestyle changes.

Many patients feel comfortable discussing issues with their local pharmacist that they may not raise elsewhere. These conversations often provide opportunities to identify problems early and support better long-term outcomes. The Common Conditions Service One of the most exciting developments in recent years has been the introduction of Ireland's Common Conditions Service. From my perspective, this service demonstrates how community pharmacy can improve access to care while supporting patients to manage appropriate conditions safely and confidently. Many common illnesses can be managed effectively without the need for a GP appointment, but that does not mean patients should be left to navigate those decisions alone. Community pharmacists are uniquely positioned to assess symptoms, recommend appropriate treatment, provide practical advice and recognise when further medical assessment is required. The Common Conditions Service reinforces an important principle: self-care and professional care are not competing concepts. Rather, they work together. By making community pharmacy a first point of contact for many everyday health concerns, patients benefit from quicker access to expert advice while GP capacity is preserved for individuals with more complex needs. It also creates opportunities to educate patients about their conditions, discuss lifestyle measures that may aid recovery and build confidence in managing similar conditions in the future.

patient care. When prescription management becomes simpler, patients are more likely to maintain adherence to treatment. It also allows pharmacy teams to spend more time focusing on meaningful patient interactions and clinical services. Technology should be viewed as an enabler, not a replacement, for professional healthcare. The pharmacist's expertise, judgement and relationship with patients remain central to safe and effective care. Looking Ahead As Superintendent Pharmacist of McCabes Pharmacy, I am continually reminded of the trust that patients place in their local pharmacist. Whether it is helping someone manage a long-term condition, providing reassurance for a minor illness, delivering a vaccination or answering a healthcare question, community pharmacy remains one of the most accessible and trusted parts of the healthcare system. As healthcare increasingly shifts towards prevention, early intervention and care delivered closer to home, pharmacists have an important contribution to make. Our accessibility, clinical expertise and regular contact with patients place us in a unique position to improve health outcomes

Technology Supporting Self-Care Technology is also transforming how patients engage with healthcare, and community pharmacy has embraced many of these developments. At McCabes Pharmacy, digital services such as DigiScript have made it easier for patients to manage repeat prescriptions, helping improve convenience and support continuity of treatment. While technology undoubtedly improves efficiency, its greatest value lies in supporting better

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and support more sustainable healthcare delivery. What we see every day in practice is consistent with the vision outlined by FIP, which recognises pharmacists as key enablers of safe and effective self-care. Patients want to take a more active role in managing their health, but they also want access to trusted healthcare professionals who can guide and support them when needed. www.selfcare.fip.org For me, self-care is not about asking patients to manage alone. It is about giving them the confidence, knowledge and support to take an active role in their health while knowing expert advice is readily available when they need it. As pharmacy services continue to evolve, I believe community pharmacy will play an increasingly important role in prevention, early intervention and improving access to care across Ireland. Ultimately, successful selfcare is not measured by how independently patients manage their health, but by how confidently they do so with the support of the right healthcare professionals. Community pharmacists have always been an important part of that support network, and I believe our role will become even more important in the years ahead.

Marketing Insight: Oral Health

The Value of the Oral Health Market Oral Health: A Growing Opportunity for Community Pharmacy As consumers increasingly take a proactive approach to their health and wellbeing, oral care continues to represent an important and resilient category within the Irish retail market. From everyday essentials such as toothpaste and toothbrushes to increasingly sophisticated products targeting sensitivity, gum health, whitening, enamel protection and interdental cleaning, the category presents community pharmacy with significant opportunities for both growth and meaningful patient engagement. The scale of the market should not be underestimated. The value of Ireland's oral care market reached an estimated ¤181 million in retail sales during 2025, according to Euromonitor International. Looking ahead, the market is forecast to record a current-value compound annual growth rate of approximately 5% through to 2030, supported by population growth, increased consumer expenditure and changing attitudes towards preventative oral care. This makes oral health a valuable consideration for pharmacy teams as they look beyond the traditional high-performing OTC categories and consider opportunities across the wider consumer health landscape. From Essential Purchase to Preventative Health One of the particular strengths of oral care is its position as a repeatpurchase category. Toothpaste, toothbrushes, mouthwashes and other oral hygiene products are everyday necessities rather than occasional purchases. However, consumer expectations are changing. The traditional emphasis on basic cleaning and cavity prevention has expanded considerably, with shoppers increasingly looking for products offering additional or specialist benefits. Sensitivity, gum health, enamel protection, dry mouth, whitening, fresh breath and denture care all provide opportunities for more targeted recommendations. Current market analysis points towards increasing consumer interest in prevention and premiumisation, including greater adoption of electric toothbrushes and whitening products. Specialist and multi-benefit toothpastes and brushes have also helped support value growth. For pharmacy, this shift is particularly relevant. While supermarkets and online retailers

can compete strongly on everyday oral-care essentials, community pharmacy has the advantage of professional advice and the ability to help consumers select products according to individual need. Pharmacy's Point of Difference Oral health is an area in which conversations at the pharmacy counter can add considerable value. Gum disease, for example, is extremely common. The HSE notes that many adults in Ireland have some degree of gum disease and that most people experience it at least once. Early-stage gingivitis may present with bleeding gums and bad breath, while untreated disease can progress to periodontitis and ultimately contribute to tooth loss. Similarly, patients may seek advice about mouth ulcers, dental pain, sensitive teeth, dry mouth, denture problems or suitable oralcare products. Pharmacists and their teams therefore occupy an important position between routine selfcare and professional dental intervention. They can recommend appropriate products while recognising symptoms requiring assessment by a dentist or other healthcare professional. This ability to combine product availability with trusted advice remains an important differentiator for community pharmacy. Premiumisation Creates Value The growth opportunity is not simply about selling greater quantities.

toothpastes, therapeutic mouthwashes, interdental brushes, flossing products and home-whitening solutions.

2023 to April 2024, demonstrating the considerable commercial importance of self-care to Irish community pharmacy.

Euromonitor's latest analysis identifies prevention and innovation as important growth opportunities within Ireland, with interdental cleaning and tooth whiteners among the adjacent categories attracting consumer interest.

At the same time, the role of community pharmacy within the Irish healthcare system continues to expand. The Community Pharmacy Agreement 2025 recognised pharmacies as an accessible part of frontline healthcare and established a pathway towards expanded services and greater integration.

The Irish market also remains highly competitive. ColgatePalmolive and Haleon collectively account for more than half of the market according to Euromonitor's 2026 analysis, demonstrating the continuing strength of established and trusted oral-health brands. For pharmacy owners, however, category development should extend beyond simply stocking recognised names. A wellmerchandised oral-health fixture can encourage consumers to think in terms of a complete oral-care routine, rather than purchasing toothpaste alone. Toothpaste can sit at the centre of the category, supported by complementary solutions for gum health, sensitivity, interdental cleaning, mouthwash and other individual needs. An Important Consumer Health Category The opportunity comes against the backdrop of a sizeable Irish consumer-health market. Previous IQVIA analysis published by Irish Pharmacy News valued Ireland's total OTC market at ¤571 million for the 12 months from May

Oral care is increasingly characterised by premiumisation, as consumers demonstrate willingness to pay more for products that offer specific benefits or more sophisticated technology. Electric toothbrushes and replacement heads are an obvious example, but the trend extends across specialist

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Oral health fits naturally within this wider emphasis on prevention, self-care and early intervention. For pharmacy teams, the category therefore delivers value on two fronts. Commercially, it provides a substantial market built around frequent repeat purchasing with opportunities for premiumisation and cross-category sales. Professionally, it provides another opportunity for pharmacy teams to engage consumers in preventative healthcare and provide trusted advice. With Ireland's oral-care market already estimated at ¤181 million and further value growth anticipated, the category deserves attention as an important component of the wider pharmacy retail offering. The opportunity for community pharmacy lies in moving oral care beyond the everyday toothpaste purchase — using expertise, appropriate product selection and effective merchandising to establish pharmacy as a destination for complete oral health and preventative care.

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Marketing Insight: Digestive Health

Gut Health: Have We Been Overcomplicating It? Why fibre deserves more attention, probiotics deserve more precision, and pharmacy teams may be better placed than almost anyone to cut through the noise Written by Róisín Cahill, MPSI, Pharmacist and Co-Founder of RoCa Healthcare. Róisín Cahill, MPSI, is a Trinity College Dublin-trained pharmacist and co-founder of RoCa Healthcare. She works with Crohn's & Colitis Ireland, Spinal Injuries Ireland, the Coeliac Society of Ireland, 15 hospital teams and 350 healthcare professionals in the public and private secto to support multidisciplinary approaches to digestive health and immune support. RoCa Healthcare's digestive-health range includes SylliFlor, SylliFlor Calcium and ColoDan Whole Colostrum.

to protein powders, collagen supplements or the latest wellness trend. Its biggest problem? Nobody gave fibre a good marketing department.Big Pharma can't patent fibre, so there is little commercial incentive to promote it. Meanwhile, interest in gut health has exploded. That's undoubtedly brought exciting scientific advances, with research centres such as APC Microbiome Ireland transforming our understanding of the gut microbiome and its role in health. At the same time, marketing has often travelled faster than the evidence, leaving patients overwhelmed by conflicting advice and spending money on products that may not be right for them. For a nation that will happily discuss almost anything, we remain remarkably shy about our bowels. I trained at Trinity College Dublin and spent over a decade in community pharmacy, where "my stomach just isn't right" was a near-daily conversation. Constipation, bloating, reflux, IBS, medication-related bowel changes and the whispered, "it's my bowels," were all commonplace. Through RoCa Healthcare, my Dad, Pat, and I work with charities, hospital teams and healthcare professionals across Ireland to

improve digestive health and help remove the stigma surrounding toilet talk.The deeper I go into gut health, the more convinced I become that early intervention can be life-changing. Yes, we're living longer, but are we dying longer? If fibre was a drug, it would probably be one of the most prescribed medicines in the world. The average Irish adult consumes only around 14 g of fibre per day, well below the recommended 24–29 g daily. Yet fibre rarely receives the attention given

Patients now ask about probiotics, prebiotics, digestive enzymes, fermented foods, SIBO and "leaky gut", sometimes all within the same consultation. Their curiosity is welcome. The confusion that follows is not. Not all probiotics are created equal ‘’Pharmacist recommends a probiotic" implies a single intervention. It isn't. Systematic reviews in IBS consistently show that probiotic effects are often strain, dose and outcome-specific. Different strains may produce

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completely different clinical outcomes, even when sold under the same broad label of "probiotic." The gut microbiome contains around 38 trillion microorganisms, comprising hundreds of bacterial species. Although the microbiome is remarkably diverse, much of its activity is driven by less than 100 dominant bacterial species that perform many of the essential functions for human health. Against that backdrop, the 5–10 billion bacteria contained in many commercial probiotics represent only a small addition, rather like adding a bucket of water to a swimming pool rather than attempting to refill the entire ecosystem. This is why simply advertising "billions of bacteria" can be misleading. The quality of the strains, the evidence supporting them and their ability to survive stomach acid are often far more important than the headline number on the label. One analogy I often use with patients is to imagine the gut microbiome as a thriving garden. The bacteria already living there are the flowers, shrubs and trees. Probiotics are like adding a few carefully selected new plants. Prebiotics, many of which are fermentable fibres, are the fertiliser. They feed not only those new additions but also the trillions of bacteria already established in the garden.This distinction is important.You may not need to take a probiotic indefinitely. Certain strains can be very useful after antibiotics or for specific clinical conditions, but the strain, product quality and purpose all matter. What every healthy microbiome does need is regular nourishment. A consistent intake of prebioticrich fibre helps feed beneficial bacteria every day, encouraging the production of short-chain fatty acids and supporting a healthier, more resilient gut microbiome over the long term. Long-term gut health repeatedly brings us back to the same unglamorous foundations: dietary variety, adequate fibre, movement, hydration and individual tolerance.

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Marketing Insight: Digestive Health Randomised trials have consistently shown that psyllium, a soluble fibre, improves IBS symptoms significantly better than bran, while systematic reviews have found little evidence supporting insoluble bran for symptom relief. IBS is not one condition. One patient has constipation-predominant IBS, another diarrhoea-predominant disease, and another alternates between the two, so giving everyone the same fibre recommendation is not a clinical strategy.

persistent vomiting, progressive dysphagia, unexplained irondeficiency anaemia, a significant persistent change in bowel habit, a palpable mass, severe or escalating pain, particularly in the context of age and family history.

Likewise, low-FODMAP diets can be extremely helpful for selected patients, but they are designed as a structured process of restriction, reintroduction and personalisation, not lifelong elimination diets.

Someone with significant constipation may need a stimulant laxative while dietary factors are addressed. A patient with reflux may need a PPI alongside practical lifestyle advice. A person with IBD needs appropriate medical management alongside nutritional support. A patient with IBS may benefit from dietary intervention, medication, psychological therapies, or all three.

The pharmacy opportunity isn't to become a dietitian at the counter. It is to recognise when patients have moved beyond sensible experimentation into progressively restricting their diet, and to know when specialist dietetic support is appropriate.

The fibre gap The evidence supporting fibre is difficult to ignore. A major Lancet review found higher fibre intake was associated with lower rates of cardiovascular disease, type 2 diabetes, colorectal cancer and allcause mortality, with the greatest benefits seen at around 25–29 g per day. One figure I think every pharmacist should remember is 10 grams. Dose-response analyses suggest that every additional 10 g/day of dietary fibre is associated with approximately; 9% lower cardiovascular mortality, 11% lower coronary heart disease mortality, 6% lower all-cancer mortality. These are observational associations rather than guarantees, but for an inexpensive and scalable dietary intervention, the evidence is remarkably compelling. That said, simply telling patients to "eat more fibre" can be poor advice. For someone eating very little fibre, increasing intake is sensible, but for patients with significant

bloating, pelvic-floor dysfunction, active inflammatory bowel disease, strictures or medication-induced constipation, it can be hopelessly simplistic. Telling that person to "just eat more bran" is about as useful as telling someone with insomnia to "try to sleep." Just like probiotics, not all fibre sources are the same; the type, dose, physical form, timing and rate of increase with fibre all matter. There are two main types of fibre, soluble and insoluble. Characteristics such as fermentability, viscosity and gel formation are also clinically important. That's why the feedback "fibre doesn't suit me" should trigger questions, not a full stop. Which fibre? How much? How fast did you increase it? How much fluid were you drinking? Often, "fibre doesn't suit me" really means "that particular fibre, at that dose and speed, didn't suit me." This matters a lot in IBS.

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Sometimes the best thing a pharmacist can do is refer without selling anything. It may not help today's basket value. It is still excellent pharmacy. The right question isn't "lifestyle or medication?" it's "what does this person need, right now?"

The fight between "natural" and "medical" is largely a distraction.

Constipation: Common doesn't mean simple

Where pharmacy makes the difference

Constipation is often treated as a single condition, but patients use the word to describe very different problems. Some mean infrequent stools; others mean hard stools; others describe excessive straining, incomplete emptying or a feeling of blockage.These symptoms are not interchangeable and may require very different approaches. Simply increasing laxatives without reassessing the patient's symptoms, medicines and lifestyle is not always the right answer.

Pharmacists and pharmacy teams are extraordinarily well-placed to identify medicinerelated bowel symptoms; distinguish occasional from persistent patterns; improve OTC medicine use; explain fibre without simply prescribing bran; clarify that probiotic evidence is strain-specific; spot red flags; and connect patients with the right professionals.

Medication reviews are particularly valuable. Opioids, iron supplements, calcium channel blockers and many other commonly prescribed medicines contribute to constipation, making pharmacists ideally placed to identify medicine-related causes before adding further treatment. Know when the best recommendation is no OTC recommendation The commercial growth of digestive health makes referral skills more important, not less. Red flags include GI bleeding or melaena, unexplained weight loss,

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And perhaps pharmacy's greatest contribution is making the conversation normal in the first place. Because for all our excitement about microbial diversity, shortchain fatty acids and the gut– brain axis many patients still feel embarrassed to tell us they haven't had a comfortable bowel movement in a week. That is where good pharmacy begins. So I'll finish where I started: if fibre were a drug, it would be one of the most prescribed medicines in the world. It just needs a better marketing department.

Marketing Insight: Sleep & Stress

Sleep & Stress: A Growing Opportunity for Community Pharmacy Sleep and stress have moved firmly into the mainstream of the health and wellness conversation. Increasing awareness of the relationship between sleep, mental wellbeing and physical health is influencing the way consumers approach self-care – and creating an increasingly important role for community pharmacy. For community pharmacy, this creates an opportunity that extends beyond the traditional concept of the "sleep aid". Consumers are increasingly looking at sleep and stress as part of their overall wellbeing, opening conversations around lifestyle, relaxation, nutrition, supplementation and good sleep habits. The Value of Sleep Good-quality sleep is fundamental to health. The HSE advises that most adults require around seven to nine hours of sleep each night, although individual requirements vary. Occasional sleep difficulties are extremely common and may be associated with stress, changes in routine, environmental factors, illness or other temporary circumstances. However, persistent insomnia can have a significant impact on quality of life and may require further investigation. The relationship between stress and sleep can also become cyclical. Stress and worry may make it more difficult to fall or remain asleep, while inadequate sleep can leave people feeling less able to cope with everyday pressures. This makes the pharmacy conversation particularly valuable. Rather than simply asking what a customer would like to purchase, pharmacy teams have an opportunity to establish what is actually driving the problem. How long have they been experiencing difficulty sleeping? Are they struggling to fall asleep, waking repeatedly or waking very early? Has something recently changed? Are medicines, caffeine, alcohol or lifestyle factors contributing? These conversations help distinguish occasional problems suitable for self-care from persistent or concerning symptoms requiring referral.

The Rise of the Wellness Consumer The changing consumer approach to sleep is also reflected in the wider wellness market. Sleep is increasingly discussed alongside exercise, nutrition, stress management and mental wellbeing as one of the foundations of a healthy lifestyle. This has encouraged the development of a much broader commercial category. Alongside traditional pharmacy sleep remedies, consumers are now exposed to products including herbal preparations, magnesium supplements, relaxation products, sleep sprays, aromatherapy and increasingly sophisticated sleeptracking technology. The growth of wearable devices has further increased awareness. Consumers can now wake up to a "sleep score", track the duration of different stages of sleep and monitor patterns over weeks and months. Supporting Better Sleep

Stress management can similarly involve relatively simple interventions. Exercise, relaxation techniques, spending time outdoors, maintaining social connections and creating clearer boundaries between work and personal time can all form part of a wider self-care approach. The role of pharmacy is not to medicalise every difficult night's sleep or stressful week. Instead, it is to help consumers understand when relatively straightforward changes may help and when additional support is appropriate. A Broader Pharmacy Category From a retail perspective, sleep and stress illustrate the continued blurring of the boundary between traditional OTC medicines and the wider wellness market. A customer initially seeking something to help them sleep may also be interested in broader wellbeing support, while someone purchasing vitamins or magnesium may raise concerns about tiredness, stress or poorquality sleep.

Non-pharmacological measures remain central to managing many short-term sleep problems. The HSE recommends measures such as establishing regular sleeping and waking times, developing a relaxing bedtime routine and ensuring the bedroom environment is comfortable, dark and quiet. Reducing caffeine later in the day, avoiding heavy meals close to bedtime, limiting alcohol and incorporating regular physical activity can also help support healthy sleep. Digital habits deserve particular consideration. Phones, tablets and other devices have become an almost constant presence in daily life, and encouraging a period of relaxation away from screens before bedtime may be beneficial for some consumers.

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This creates opportunities for appropriate conversations and complementary recommendations, but responsible merchandising remains important. An Evolving Opportunity The growing focus on sleep reflects a wider transformation within consumer healthcare. Consumers are no longer interested solely in treating illness. Increasingly, they are seeking products, information and services that they believe can help them feel better, function better and protect their future health. Sleep and stress sit directly within that movement. For community pharmacy, the opportunity is therefore broader than the products on the shelf. By combining an appropriate range with trusted advice, lifestyle support and clear referral pathways, pharmacy teams can establish themselves as an important destination for consumers seeking support with sleep, stress and everyday wellbeing.

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CPD: Omega-3 Continuing Professional Development

Author: Philip Calder PhD, DPhil, RNutr

CPD

School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom

60 Second Summary

1. REFLECT - Before reading this module, consider the following: Will this clinical area be relevant to my practice?

knowledge gap - will this article satisfy those needs - or will more reading be required?

2. IDENTIFY - If the answer is no, I may still be interested in the area but the article may not contribute towards my continuing professional development (CPD). If the answer is yes, I should identify any knowledge gaps in the clinical area.

4. EVALUATE - Did this article meet my learning needs - and how has my practise changed as a result? Have I identified further learning needs?

Omega-3 (sometimes referred to as n-3) fatty acids are a family of polyunsaturated fatty acids, meaning that they have multiple double bonds in their hydrocarbon chain. The term omega-3 describes the position of the double bond closest to the methyl end of that chain (i.e. it is a structural descriptor, not a functional one); this is on carbon number 3. ALA is produced in plants and is found in some nuts including walnuts, in flaxseeds and chia seeds, and in some seed oils including flaxseed, soybean and rapeseed oils. Flaxseed oil is the richest source of ALA where it constitutes about 45% of fatty acids present. ALA is an essential fatty acid (i.e. it cannot be produced in humans) and its main role seems to be as a substrate for EPA synthesis. Typical intakes of ALA are 1 to 2 g/day. Dietary intake of EPA+DHA is strongly influenced by fatty fish consumption, so that in the population, intake differs quite considerably between those who consume fatty fish regularly and those who don’t. A measurement called “omega-3 index” (O3I) has emerged as the preferred biomarker of status of EPA+DHA in the body. O3I is EPA+DHA as a percentage of total fatty acids in red blood cells. O3I can also be calculated from measurements in whole blood using a conversion factor. A number of risk factors for cardiovascular disease are modified in a beneficial way by increased intake of EPA and DHA; these include blood pressure, platelet reactivity and thrombosis, plasma triglyceride concentrations, vascular function, heart rate variability and inflammation.

3. PLAN - If I have identified a

5. WHAT NEXT - At this time you may like to record your learning for future use or assessment. Follow the

4 previous steps, log and record your findings. Published by IPN. Copies can be downloaded from www.irishpharmacytraining.ie Disclaimer: All material published is copyright, no part of this can be used in any other publication without permission of the publishers and author.

Omega-3 Fatty Acids Omega-3 fatty acids: What are they and how are they formed?

the hydrocarbon chain are called impedes endogenous production elongases and the enzymes that of EPA and DHA. The enzymes insert double bonds into the chain that catalyse the conversion of Omega-3 (sometimes referred are called desaturases. The first ALA to EPA and DHA also act on to as n-3) fatty acids are a enzyme in the pathway (delta-6 omega-6 fatty acids and convert family of polyunsaturated fatty desaturase) is the rate limiting linoleic acid to arachidonic acid acids, meaning that they have enzyme, docosapentaenoic acid is and beyond. Hence, there is multiple double bonds in their an intermediate in the conversion direct competition for metabolism hydrocarbon chain. The term of EPA to DHA and polymorphisms between the omega-3 and omega-3 describes the position in genes encoding several omega-6 fatty acids. In human of the double bond closest to enzymes in the pathway appear to diets and in the body there is a the methyl end of that chain (i.e. result in different enzyme activities it is a structural descriptor, not a and so different capacities to functional one); this is on carbon Figure 1. The structure of omega-3 endogenously produce EPA and number 3. The other important fatty acids. The methyl end is DHA from ALA. This pathway is shown on the left end of each family of polyunsaturated fatty regulated by insulin and works less structure and the carboxylic acid acids is the omega-6 family, efficiently in people with insulin group on the right. Linking these characterised by the first double It isand also in regulated by amount of EPA resistance. in the blood blood cells (e.g.two redends blood white blood is acells, hydrocarbon chain cells) bond in the hydrocarbon chain female sex hormones while zinc with the carbons linked by single (-) being on carbon number 6 from theseisstrategies However, limited a co-factor have for some of theimpact on DHA levels. or double (=) bonds the methyl end of the chain. enzymes so that zinc deficiency Eicosapentaenoic acid (EPA) which has 20 carbons and 5 double bonds in its hydrocarbon chain and docosahexaenoic acid (DHA) which has 22 carbons and 6 double bonds in its hydrocarbon chain (Figure 1) are the most studied members of the omega-3 family and are biologically active. There is a metabolic pathway to synthesise EPA and DHA from the simpler alpha-linolenic acid (ALA), which has 18 carbons and three double bonds in its hydrocarbon chain (Figure 1). This metabolic pathway obviously involves elongation of the hydrocarbon chain and insertion of additional double bonds (Figure 2). The enzymes that elongate

Figure 1. The structure of omega-3 fatty acids. The methyl end is shown on the le

each structure and the carboxylic acid group on the right. Linking these two ends

hydrocarbon chain with the carbons linked by single (-) or double (=) bonds.

CPD: Omega-3

Figure 2. The metabolic interconversion of omega-3 fatty acids

much greater abundance of linoleic acid than ALA and this restricts people’s ability to produce EPA and DHA. Research in humans has shown that either increasing intake of ALA or decreasing intake of linoleic acid results in an increase in the amount of EPA in the blood and in blood cells (e.g. red blood cells, white blood cells). However, these strategies have limited impact on DHA levels.

of algal oils is now available with some offering both EPA and DHA. Algal oils are suitable for vegetarian and vegan consumers. In fish oils, their concentrates and algal oils EPA and DHA are mainly in triglyceride form. Some pharmaceutical products provide EPA and DHA as ethyl esters. Krill oil contains less EPA and DHA than fish oil, but some is in the form of phospholipids which are claimed to have better bioavailability. Irrespective of origin, consumers should read the label and consider the amount of EPA+DHA a supplement will provide; the more the better. They should consume supplements just before, with or just after a meal to aid digestion of the omega-3s; omega-3 supplements taken “on an empty stomach” are not well digested so the benefits are lost. It is evident that using a supplement that provides EPA and DHA can markedly increase intake of those fatty acids in people who do not eat fatty fish regularly. Omega-3 fatty acids: How can body levels be measured and increases monitored?

EPA and DHA circulate in the bloodstream, are found in the membranes of all cells in the body that it is marine algae that produce EPA+DHA in the body needs to and are stored in adipose tissue. Omega-3 fatty acids: What are EPA and DHA and that these are be maintained by endogenous Figure 2. The metabolic interconversion of omega-3 fattyIn acids the bloodstream they are found the main sources and typical passed through the food chain to synthesis from ALA, which is esterified in the phospholipids, intakes? fish and beyond. Therefore, the restricted in many people in part triglycerides and cholesteryl precise EPA and DHA content of due to high linoleic acid intake. ALA is produced in plants and esters of lipoproteins and as fish depends upon their diet, stage The UK and Irish governments is found in some nuts including “free” (non-esterified) fatty acids of the life course, the temperature both recommend that people eat walnuts, in flaxseeds and chia as well as in the membranes of of the water in which they live fish regularly including fatty fish. seeds, and in some seed oils red blood cells, white blood cells Omega-3 fattyand acids:andWhat areinthe and typical the season whichmain they sources including flaxseed, soybean However, if consumers do intakes? not do and platelets. Within an individual, are caught. EPA+DHA content rapeseed oils. Flaxseed oil is the that supplements can be used amounts of EPA and DHA are and foundwildinand some tonuts including walnuts, in the flaxseeds and chia richestALA sourceis of produced ALA where it in plants can also differis between provide preformed EPA+DHA. different across different locations. constitutes about 45% of fatty farmed fish, such as salmon. The most common supplements For example several parts of the acids present. is anin essential seeds,ALAand some seed oils including flaxseed, and oils. Flaxseed oil is aresoybean so-called “fish oils”rapeseed or their brain and the eye contain high Dietary intake of EPA+DHA is fatty acid (i.e. it cannot be concentrates. Standard fish oil amounts of DHA and very little strongly influenced by fatty fish produced humans) and its main of ALA where it constitutes about is about45% 30% EPA+DHA, theinrichest source of fatty the acids present. ALA sophisticated is an EPA, indicating consumption, so that in the role seems to be as a substrate for remaining 70% being other fatty mechanisms for selectivity and population, intake differs quite EPA synthesis. Typical intakes of (i.e. acids. Concentrates ofits EPA+DHA essential fatty acid it cannot be produced in humans) and main role seems to be as a retention between body locations considerably between those ALA are 1 to 2 g/day. up to 90% are now available, and between EPA and DHA. EPA who consume fatty fish regularly offering a much EPA+DHA and DHA levels can be measured substrate forinEPA synthesis. Typical intakes of ALA are 1 tohigher 2 g/day. EPA and DHA are found and those who don’t. Estimating content. The ratio of EPA to DHA in any body location that is fairly high amounts in seafood, EPA+DHA intake can be difficult in standard fish oils is often 1.5 to accessible and they are commonly especially in fatty fish (sometimes because of the infrequency 1 but the variety of oils available measured in whole blood, in called oily fish), in the blubber and irregularity of fatty fish now provide a variety of ratios. blood plasma or serum, in blood and tissues sea mammals like found consumption andhigh the inaccurate EPAofand DHA are in fairly amounts in seafood, especially in fatty fish (sometimes There is insufficient information to plasma phospholipids and in red whales and seals, in supplements data on EPA+DHA content of identify whether there is an ideal blood cells. The levels of EPA like fish oils, cod liver oil and krill typesand of fish. Reportedof sea mammals like whales and called oily fish), in thedifferent blubber tissues in often quoted ratio of EPA to DHA. Fish oils can and seals, DHA are most oil, in some algal oils, and in a “average” population intakes also contain fat soluble vitamins. as a percentage of total fatty limited number of pharmaceutical of EPA+DHA in manyoil Western supplements like oils, cod liver and krill oil, in some algal oils, and acids in a present limited number The presence of contaminants although absolute grade preparations. There is at fish countries, including the UK and such as mercury is limited through concentrations, such as amount least a 10-fold range in content Ireland are in the range of 100 to of pharmaceutical preparations. There is oil atprocessing least a for 10-fold range inper content of can also be used. their removal. ml of blood, of EPA+DHA per portion (serving) grade 300 mg/day. In the past available algal oils, There is a relationship between of seafood, with fatty fish (e.g. initially for use in infant fatty fishof consumption the amounts trout, of EPA or DHA in the mackerel, salmon, trout, herring EPA+DHA per portionWhere (serving) seafood, withproduced fatty fish (e.g. mackerel, salmon, formulas, provided up to 45% is low, intakes of EPA+DHA are different blood pools: the different and sardines) being the richest sources. It is important note low. This means that the level of not containalgae the same DHA andimportant little EPA, butto a variety herring andtosardines) being the richest sources. It is note thatpools it isdomarine

that produce EPA and DHA and that these are passed through the food chain to fish and beyond. Therefore, the precise EPA and DHA content of fish depends upon their diet, stage of the life course, the temperature of the water in which they live and the season in which they are caught. EPA+DHA content can also differ between wild and farmed fish, such as

51 Figure 3. Dose-response and time course of EPA and DHA incorporation into human platelets. Uptake of (A) EPA and (B) DHA into platelets of human participants taking different doses of fish oil for one year. Increasing EPA and DHA doses equated to zero □, one ■, two ○, or four ● meals weekly of fatty fish. Figure derived from Browning et al. (2012).

in women with low starting DHA status. DHA has an important structural role in the eye and brain, and its supply early in life when these tissues are developing is known to be of importance in terms of optimising visual and neurological development. For this reason, it is very important that pregnant and breast-feeding women have adequate DHA intake. DHA is required to be added to infant formula in the European Union, in recognition of its role in early childhood visual and cognitive development. Recent studies have highlighted the potential for EPA and DHA to contribute to enhanced mental development and improved childhood learning and behaviour.

3. Dose-response and time course of EPA and DHA incorporation into human levels but they are related to one another. The levels of EPA and DHA in all blood pools are higher in fatty fish consumers than in non-consumers. Likewise, studies using supplements show that there is a clear and linear dose-response relationship between EPA+DHA intake and the levels of those fatty acids in whole blood, plasma, serum, plasma phospholipids, red cells, white cells and platelets. In other words, the higher the intake, the higher the levels in blood. However, it is important to note that some blood pools change faster than others; this is related to the rate of turnover of the pool. For example, incorporation of EPA and DHA into white cells is faster than into red cells. So there is a doseand time-element to EPA and DHA incorporation. This is shown for human platelets in Figure 3. A limited number of human studies have shown that when intake of

EPA+DHA is increased through use of supplements, then EPA and DHA levels increase in the heart, liver and skeletal muscle and probably in many other tissues, although increasing brain content of DHA in adults seems difficult to achieve. If people stop taking EPA+DHA supplements, eventually the amounts of EPA and DHA present return to their presupplementation levels.

is considered undesirable while O3I greater than 8 is considered desirable. Measuring O3I can tell a person their EPA+DHA status and if it is low they can act to increase it by increasing fish consumption, using an EPA+DHA supplement, increasing ALA intake (e.g. from flaxseeds and ALA-containing oils) or decreasing linoleic acid intake. They can monitor the effectiveness of their chosen action by retesting at least 3 months later.

number of risk factors for elets. Uptake of (A) EPA and (B) DHA into platelets of human participantsAcardiovascular taking disease are modified in a beneficial way

nt doses of fish oil for one year. Increasing EPA and DHA doses equated to zero □, by increased intake of EPA

and DHA; these include blood

platelet reactivity and wo ○, or four ● meals weekly of fatty fish. Figure derived from Browning etpressure, al. (2012).

thrombosis, plasma triglyceride concentrations, vascular function, heart rate variability and inflammation. Thus, there is a key role for EPA+DHA in prevention and slowing progression of cardiovascular disease. This is recognised by several “heart health” organisations around the world in recommendations supporting EPA+DHA for prevention of cardiovascular diseases typically at doses up to 1000 mg/day. Furthermore, EPA+DHA can be used at higher doses (2000 to 4000 mg/day) for triglyceride lowering in those with hypertriglyceridemia.

urement called “omega-3 index” (O3I) has emerged as the preferred biomarker of

EPA+DHA in the body. O3I is EPA+DHA as a percentage of total fatty acids in red A measurement called “omega-3

index”from (O3I) has emerged as the lls. O3I can also be calculated measurements in whole blood a Omega-3 fatty acids: Whatusing do preferred biomarker of status of EPA+DHA in the body. O3I is EPA+DHA as a percentage of total fatty acids in red blood cells. O3I can also be calculated from measurements in whole blood using a conversion factor. This has enabled measurements of EPA+DHA status using whole blood or whole blood spots on filter paper. O3I of less than 4

they do?

on factor. This has enabled measurements of EPA+DHA status using whole blood or Acting through the mechanisms described earlier, EPA and DHA

have a wide undesirable range of physiological ood spots on filter paper. O3I of less than 4 is considered while O3I roles, which are linked to certain health benefits across the life course. Trials of EPA+DHA or DHA alone in pregnant women have found reduced risk of early and very early preterm birth, especially

han 8 is considered desirable. Measuring O3I can tell a person their EPA+DHA

nd if it is low they can act to increase it by increasing fish consumption, using an

HA supplement, increasing ALA intake (e.g. from flaxseeds and ALA-containing oils)

asing linoleic acid intake. They can monitor the effectiveness of their chosen action

ting at least 3 months later.

Table 1. Health claims for EPA and DHA approved by the European Food Safety

CPD: Omega-3

Authority

DHA maternal intake contributes to the normal brain development of the foetus and breastfed infants DHA maternal intake contributes to the normal development of the eye of the foetus and breastfed infants DHA intake contributes to the normal visual development of infants up to 12 months of age DHA contributes to maintenance of normal brain function DHA contributes to the maintenance of normal vision DHA and EPA contribute to the maintenance of normal blood pressure DHA and EPA contribute to the maintenance of normal blood triglyceride levels EPA and DHA contribute to the normal function of the heart Table 1. Health claims for EPA and DHA approved by the European Food Safety Authority

Omega-3 fatty acids: Are there

in cool and dark conditions, and

EPA+DHA for most people are below these recommendations.

Supplements providing EPA+DHA

One emerging concern is a

The Australian National Heart

number of consumers over a long

EPA+DHA supplementation and

500 mg EPA+DHA/day for primary

cause some issues, especially at high doses. For example, they may cause a fishy aftertaste, fishy burps, fish-smelling breath or sweat, nausea, headaches, diarrhoea, bloating, heartburn or acid reflux, particularly when used at high doses or when taken on an empty stomach. Taking supplements with meals and splitting doses can reduce these effects.

shown across several trials and confirmed in some meta-analyses. Once again this is related to higher doses of EPA+DHA and there is no identified risk for intakes below about 1 g/day. In fact, several studies report decreasing risk of atrial fibrillation with increasing intake of EPA+DHA up to about 1 g/day. This suggests a U-shaped relationship between EPA+DHA intake and risk of atrial fibrillation.

the US Association of Nutrition and Dietetics recommends at least 500 mg EPA+DHA/day. A consortium of researchers and neonatology, paediatric and obstetrics and gynaecology societies recommended that women of childbearing age should consume at least 250 mg/d of EPA+DHA from the diet or supplements, and in pregnancy an additional 100 to 200 mg/d of DHA. Furthermore, they recommended that since women with a low DHA intake and/ or low blood levels of DHA have an increased risk of preterm birth and early preterm birth, they should consume 600 to 1000 mg/d of EPA+DHA or DHA alone.

any concerns? not stockpile supplies. Omega-3 fatty acids: Are there any concerns?

have been widely used by abeen large widely Supplements providing EPA+DHA have bybetween a large number ofrecommends consumers Foundation 250 to possible used association

period of time. They are generally prevention of heart disease, atrial tolerated fibrillation, which has been over a long period of time. They are generally well and safe but can cause somewhile well tolerated and safe but can

issues, especially at high doses. For example, they may cause a fishy aftertaste, fishy burps, fish-smelling breath or sweat, nausea, headaches, diarrhoea, bloating, heartburn or acid

reflux, particularly when used at high doses or when taken on an empty stomach. Taking

EPA and DHA have consistent anti-inflammatory effects. These may contribute to many of their health benefits, since inflammation is a common feature of many conditions including cardiovascular diseases, metabolic diseases, cognitive decline, sarcopenia (loss of lean mass) and so on. However, these conditions involve multiple factors and it is often difficult to separate out an effect of omega-3 fatty acids on inflammation from other possible actions. However, some conditions such as rheumatoid arthritis have inflammation as a central feature of their pathology and symptom burden.

supplements with meals and splitting doses can reduce these effects. EPA and DHA are susceptible to

Omega-3 fatty acids: What are complex oxidative degradation, EPA and DHA are susceptible to complex oxidative degradation, producing primary lipid the recommendations? producing primary lipid peroxides and secondary oxidation products such as aldehydes and ketones. If this occurs in an oil or supplement, it obviously decreases the amount of EPA and DHA present while the products may have undesirable effects once consumed. Factors influencing the oxidation rate in omega-3 oil supplements, including light and oxygen exposure, temperature, antioxidant content, and the presence of water or heavy metals. The degrees of primary and secondary oxidation are presented as peroxide value and anisidine value, respectively, and there are industry limits on these values. In order to limit the possibility of oxidation, consumers should purchase fresh supplements (based on distant future best before dates), store supplements in sealed containers

Recognition of the benefitsand ketones. If this occurs peroxides and secondary oxidation products such as aldehydes of EPA+DHA for human health has resulted in many

in an oil or supplement, it obviously decreases the amount of EPA and DHA present while recommendations for their intake, preferably from eating fish. Often

Some organisations have

additional DHA for pregnant or lactating women on top of the recommendation for EPA+DHA for adults recognising the important role of DHA in early life visual and cognitive development (Table 2). A recent systematic review of recommendations for EPA+DHA identified that the most frequently recommended intakes for adults are 250 mg/day EPA+DHA and 250 mg/day EPA+DHA plus an additional 100 to 200 mg/ day DHA in pregnancy. In many Western countries including the UK and Ireland, daily intakes of

for intake of EPA+DHA from

is a recommendation for the products may have undesirable effects oncethere consumed. Factors influencing discussed safethe upperoxidation limits supplements. The European Food rate in omega-3 oil supplements, including light and oxygen exposure, temperature, Safety Authority set a safe upper

limit for combined EPA and DHA antioxidant content, and the presence of water or heavy metals. The degrees of primary and from supplements of 5 g/day (i.e. 5000 mg/day) stating this would

secondary oxidation are presented as peroxide value and anisidine value, respectively, and be “without expected adverse

Table 1 summarises the health claims that are permitted in the European Union based upon evaluation of evidence from human trials by the European Food Safety Authority. The successful substantiation of these claims indicates the strength of the evidence that exists in these named areas of human physiology.

effects”. They also set a safe

upper limit for supplemental EPA there are industry limits on these values. In order to limit the possibility of oxidation, alone of 1.8 g/day (i.e. 1800 mg/

and for supplemental DHA consumers should purchase fresh supplements (based on distant futureday) best dates), alone of 1 before g/day (i.e. 1000 mg/ day). The incompatibility of these

store supplements in sealed containers in cool and dark conditions, andlimits notseems stockpile to be due the doses supplies.

that have been used in human trials of EPA, DHA and EPA+DHA.

One emerging concern is a possible association between EPA+DHA supplementation and atrial fibrillation, which has been shown across several trials and confirmed in some metaanalyses. Once again this is related to higher doses of EPA+DHA and there is no identified risk for intakes below about 1 g/day. In fact, several studies report decreasing risk of atrial

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Marketing Insight: Smoking Cessation

Smoking Cessation: Why Community Pharmacy Has Never Been More Important ‘Community pharmacy is one of the most accessible healthcare settings in Ireland. Through trusted advice, support with Nicotine Replacement Therapy, practical patient engagement and referral into specialist HSE cessation services, pharmacists and pharmacy teams can help more people take meaningful steps towards becoming smoke-free.’ Written by Shane O'Neill, Director of Pharmacy, Uniphar, Supply Chain and Retail

These everyday interactions provide opportunities to start conversations about smoking and its impact on health. Sometimes a simple question or a brief intervention is enough to encourage someone to consider making a quit attempt. Even if a patient is not ready to quit immediately, that engagement can help increase awareness and prepare them for future action. Importantly, community pharmacy offers something many healthcare settings cannot: regular contact. The ability to engage with patients repeatedly over time creates opportunities to reinforce positive messages, provide encouragement and support individuals throughout their quit journey. Trust Remains Community Pharmacy's Greatest Strength

Few healthcare interventions offer the same potential to improve health outcomes as helping someone stop smoking. While smoking prevalence in Ireland has reduced significantly over recent decades, tobacco use remains one of the leading causes of preventable illness and premature death. Smoking continues to be a major contributor to cardiovascular disease, respiratory illness, cancer and numerous long-term health conditions. For healthcare professionals, supporting people to quit remains one of the most effective ways of improving both individual and population health. Community pharmacy has an important role to play in that effort. As one of the most accessible healthcare settings in the country, pharmacies are uniquely positioned to engage with patients regularly, provide trusted advice and support individuals through what is often a challenging journey towards becoming smokefree. At a time when healthcare

policy is increasingly focused on prevention, early intervention and self-care, community pharmacy has never been better placed to help people take positive steps towards improving their health. Every Conversation Creates an Opportunity The reality is that most successful quit attempts do not happen overnight. Many smokers have attempted to quit previously and understand the health risks associated with tobacco use. However, nicotine dependence is complex and stopping smoking involves much more than simply making a decision to quit. This is where pharmacy teams can make a meaningful difference. A smoking cessation conversation rarely begins with a patient specifically requesting help to stop smoking. More often, opportunities arise during routine interactions when patients are seeking advice for a cough, collecting medicines, discussing a diagnosis or accessing wider healthcare services.

Community pharmacists are among the most trusted healthcare professionals in Ireland. Patients frequently seek advice on health matters from various sources, including social media, the internet, family and friends. While access to health information has never been greater, the quality and reliability of that information can vary significantly. Pharmacists play a valuable role in helping patients navigate information and providing evidence-based advice that is tailored to their individual circumstances. Smoking cessation conversations require empathy as well as clinical expertise. Many smokers have experienced unsuccessful quit attempts in the past and may feel discouraged or unsure about trying again. Community pharmacy teams are well placed to provide practical, non-judgemental support that focuses on helping patients take small but meaningful steps towards becoming smoke-free. The trusted relationships that pharmacists often develop with

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their patients can be a powerful factor in supporting behaviour change and maintaining motivation over time. The Continuing Importance of Nicotine Replacement Therapy Nicotine Replacement Therapy, or NRT, remains one of the most established and evidence-based supports available to people who want to stop smoking. A wide range of options, including patches, gum, lozenges, inhalators and mouth sprays, allows treatment to be tailored to individual needs and preferences. The role of the pharmacy team in

55 helping patients choose the most appropriate product should not be underestimated. Many smokers are unaware of the different NRT options available or may have misconceptions about how these products should be used. Others may discontinue treatment too early or fail to use products consistently, reducing their chances of success. Pharmacists can help patients understand the available options, ensure products are used correctly and provide reassurance throughout treatment. The recommendation of a trusted healthcare professional can often make the difference between a patient persisting with a quit attempt or returning to smoking. However, successful smoking cessation is rarely about products alone. NRT can play an important role in managing nicotine withdrawal symptoms, but long-term success depends on addressing the behavioural aspects of smoking as well.

Behaviour Change Is at the Heart of Smoking Cessation One of the biggest challenges in quitting smoking is that tobacco use often becomes deeply embedded within daily routines. Smoking can be associated with morning habits, social interactions, work breaks, stress management and a variety of other triggers. This means that smoking cessation is not only about managing nicotine dependence, but also about changing behaviours that may have developed over many years. Community pharmacy teams are ideally positioned to help patients identify these triggers and develop practical strategies to overcome them. Each interaction provides an opportunity to discuss progress, celebrate milestones and support patients through setbacks that may arise along the way. Relapse is often part of the cessation journey and should not be viewed as failure. Instead, it can provide valuable learning that helps shape future quit attempts. The accessibility of community pharmacy allows pharmacists to provide ongoing encouragement and support throughout this process, helping patients remain focused on their long-term goals. Working Together to Improve Quit Success While community pharmacy plays an important role in smoking cessation, it should not be viewed

as working in isolation. Many patients benefit from referral into specialist supports such as the HSE Quit Service, which provides access to trained Smoking Cessation Advisors who can offer more intensive behavioural support and personalised quit plans. These services can significantly strengthen a quit attempt by providing patients with dedicated support throughout their cessation journey. They also offer structured follow-up that helps individuals remain motivated and accountable during what can be a difficult period. An additional benefit is that individuals engaging with HSE smoking cessation services may be eligible to receive Nicotine Replacement Therapy free of charge for a defined period. This can help remove financial barriers and ensure patients have access to the tools they need to support a quit attempt. Community pharmacy teams are well placed to identify patients who may benefit from these services and encourage them to engage with the supports available. This collaborative approach combines the accessibility of pharmacy with the specialist expertise offered through dedicated smoking cessation programmes. Together, these interventions can significantly improve the likelihood of successful long-term cessation.

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Supporting a Healthier Ireland Smoking cessation aligns closely with the broader shift towards prevention and proactive healthcare. Community pharmacists are increasingly involved in vaccination services, medicines optimisation, health screening and the management of common conditions. Supporting people to stop smoking is a natural extension of this evolving role. The benefits extend beyond individual patients. Reduced smoking prevalence contributes to lower rates of chronic disease, improved quality of life and reduced pressure on healthcare services. Few healthcare interventions can deliver such widespread benefits. Looking Ahead Community pharmacy has a vital role to play in Ireland's efforts to reduce smoking-related harm. Through trusted relationships, evidence-based advice, support with Nicotine Replacement Therapy and referral into specialist cessation services, pharmacists and pharmacy teams can help more people take successful steps towards becoming smoke-free. Every quit attempt matters. Every conversation matters. And every patient who successfully stops smoking represents a significant improvement in health and wellbeing. As healthcare continues to place greater emphasis on prevention, community pharmacy will remain a key partner in helping people quit smoking and supporting a healthier future for communities across Ireland.

Marketing Insight: Women’s Health

Women’s Health: A Growing Opportunity for Community Pharmacy Women’s health has undergone a significant transformation in recent years. Conditions and symptoms that were once discussed relatively little – from menstrual health and fertility to menopause, intimate health and healthy ageing – have moved firmly into the mainstream health conversation. For community pharmacy, this represents both an important professional responsibility and a significant opportunity. Women are not a single consumer group with a fixed set of healthcare needs. Their requirements evolve considerably throughout life, from adolescence and the reproductive years through pregnancy and motherhood to perimenopause, menopause and later life. Increasingly, women are looking for products, advice and services specifically designed around those different stages. This represents a marked shift from the traditional retail perception of "women's health" as a category dominated primarily by pregnancy products and feminine hygiene. Today's women's health market encompasses menstrual wellbeing, sexual and reproductive health, contraception, fertility, intimate health, bladder health, bone health, nutritional supplementation, skin and hair changes, menopause and healthy ageing. For community pharmacy, the opportunity lies in recognising these changing needs and becoming a trusted destination for women's health throughout the life course. Women's Health Moves Up the Agenda This shift is particularly evident in Ireland, where women's health has become a major healthcare policy priority. The Government's Women's Health Action Plans have driven investment and service development across areas including contraception, fertility, endometriosis, menopause and specialist gynaecological care. In July 2026, Ireland launched its Third National Women's Health Action Plan for 2026–2027, continuing the programme of reform and building on the investment and service expansion delivered through the previous plans. This greater policy focus has been accompanied by a wider cultural change.

Women are increasingly informed about their health, more prepared to discuss symptoms and more likely to seek solutions rather than simply accept problems as an unavoidable part of being female.

year State investment and includes a dispensing payment to participating pharmacies.

This is particularly evident around menopause, but the trend extends much further.

It brings women into pharmacy specifically because of menopause and provides opportunities for wider conversations about symptoms, adherence, appropriate medicine use and general health and wellbeing.

Heavy or painful periods, endometriosis, polycystic ovary syndrome, fertility, contraception, vaginal health and changes associated with ageing are increasingly discussed publicly and openly. For pharmacists and their teams, this creates opportunities for conversations that may previously have been difficult to initiate. Menopause Changes the Conversation Perhaps no area demonstrates the transformation in women's health more clearly than menopause. For generations, many women simply endured symptoms with relatively little discussion or support. Today, awareness of perimenopause and menopause has increased dramatically, alongside understanding of the potentially wide-ranging symptoms women may experience. The Department of Health has acknowledged that menopause has historically not been openly discussed and has made improving menopause care a priority within its women's health strategy. Six specialist menopause clinics have been established nationally for women experiencing complex symptoms. A major change came in June 2025 with the introduction of Ireland's State-funded HRT arrangement. Under the scheme, eligible prescribed HRT medicines and products for the management of symptoms associated with all stages of menopause are provided without charge through participating community pharmacies. The initiative represented a ¤20 million full-

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The significance for community pharmacy goes beyond dispensing.

It also reinforces pharmacy's increasingly important position within women's healthcare. Beyond HRT Menopause should not, however, become synonymous with women's health. There are considerable opportunities for pharmacy to support women who are experiencing symptoms associated with menopause regardless of whether they use HRT. Vaginal dryness and changes to intimate health, for example, can have a substantial effect on comfort and quality of life yet may still be difficult for some women to discuss. Appropriate vaginal moisturisers and lubricants can play an important role in symptom management, while pharmacists can identify symptoms that require medical assessment. Sleep disturbance, changes in skin and hair, weight concerns and bone health may also prompt women to seek advice. This creates natural links between women's health and other pharmacy categories including skincare, oral health, vitamins and minerals, sleep, nutrition and healthy ageing. The commercial opportunity therefore does not necessarily reside within one physical "women's health" fixture. Instead, women's needs increasingly extend across the pharmacy.

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Intimate Health and the Value of Advice Intimate health remains one of the areas where community pharmacy has a particularly important advantage over other retailers. Products for thrush, vaginal dryness, cystitis symptom relief, period care and intimate hygiene are widely available through multiple retail channels. However, the presence of a pharmacist or trained pharmacy team provides something an online marketplace or supermarket cannot easily replicate: a confidential conversation and professional judgement. Someone who believes she has recurrent thrush, for example, may actually require assessment rather than another cycle of self-treatment. Similarly, urinary symptoms may require investigation, while unusual bleeding, persistent pain or recurrent symptoms should prompt referral. The ability to recognise when self-care is appropriate – and equally when it is not – is central to pharmacy's value. Privacy is important too. Accessible consultation rooms and a pharmacy culture in which customers feel comfortable requesting a private conversation can make it easier for women to raise concerns they may otherwise postpone discussing. Contraception and an Expanding Pharmacy Role Sexual and reproductive health is another area in which the role of Irish community pharmacy is evolving. Emergency contraception is already an established pharmacy service. In Ireland, emergency contraception is available free to women aged 17 to 35 through the Free Contraception Scheme, while medical-card holders can access emergency contraception directly through a pharmacy without first obtaining a GP prescription.

57 The direction of travel points towards a still greater role. The Pharmaceutical Society of Ireland has confirmed that a new pharmacy contraception service is being developed to enable pharmacists to continue prescriptions for short-acting reversible contraception beyond 12 months. The service is planned for introduction during 2026 as part of the wider expansion of community pharmacy services. These developments are important because they change the nature of women's interaction with community pharmacy. Pharmacy is increasingly becoming not simply somewhere women collect prescribed medicines, but somewhere they access healthcare. As the scope of pharmacy practice expands, that distinction will become increasingly important. Fertility, Pregnancy and Motherhood The reproductive years continue to represent another substantial component of the women's health category. Pregnancy tests, ovulation tests, fertility products, folic acid and other pregnancy supplements are established pharmacy categories, but consumers are increasingly seeking information alongside products.

Trust built during one interaction can therefore develop into a longterm relationship. The Midlife Consumer From a retail perspective, the midlife female consumer is particularly important. Women in their 40s, 50s and 60s may simultaneously be thinking about menopause, sleep, energy, weight, cardiovascular health, bone health, skincare, hair changes, sexual wellbeing and healthy ageing. This creates significant crossover between women's health and the wider wellness market. It also demonstrates why category management based entirely around individual conditions can miss opportunities. A customer does not necessarily think of herself as purchasing from a "menopause category", a "VMS category" or a "sleep category". She is often simply looking for ways to feel better and remain healthy as her needs change.

Merchandising the Opportunity For pharmacy owners, women's health presents an interesting category-management challenge because relevant products span so many areas of the store.

Women's health is no longer a niche retail category.

Consumers looking for vaginal moisturisers, menopause-related products or bladder-health solutions should not have to search through poorly defined shelves or ask loudly at a busy counter where something is located.

It is an expanding healthcare and wellness market encompassing different needs across almost every stage of a woman's life.

Thoughtful merchandising can make sensitive categories easier to navigate. Pharmacies can also consider women's health campaigns at appropriate times of the year, using window displays, in-store information, social media and pharmacy websites to highlight available support. Importantly, messaging should be inclusive and evidence-based rather than fear-driven.

Pharmacies that understand that wider journey can provide a more coherent experience.

The objective should be to position pharmacy as somewhere women can comfortably ask questions.

Women's Health and Healthy Ageing

From Product Supplier to Healthcare Destination

As women move beyond menopause, priorities change again.

Perhaps the greatest opportunity presented by women's health is not any individual product category.

Bone health becomes increasingly important, as does cardiovascular health, muscle strength, nutrition and maintaining independence.

Pregnancy itself creates further opportunities for professional support. Many women are understandably cautious about using medicines while pregnant and frequently seek reassurance from their pharmacist about what they can safely take for common conditions.

Women may also experience continuing vaginal and urinary symptoms long after the classic symptoms associated with menopause have diminished.

A woman may first engage with her pharmacy about acne as a teenager, contraception as a young adult, fertility and pregnancy later, children's health as a parent, followed eventually by perimenopause, menopause and healthy ageing.

This connects women's health directly with another major pharmacy trend: healthy ageing.

Few retail environments have the opportunity to maintain that relationship over several decades.

Following birth, needs change again.

The modern ageing consumer increasingly wants to remain active, independent and well rather than simply manage illness. Products and services supporting prevention and wellbeing therefore have growing relevance.

Community pharmacy does.

The important commercial lesson is that these should not be viewed as isolated transactions. A woman purchasing a pregnancy test today may potentially interact with the same pharmacy throughout pregnancy, early motherhood and many subsequent stages of life.

Pharmacy teams can help women understand appropriate self-care while reinforcing the importance of screening, vaccination, physical activity, balanced nutrition and engagement with other healthcare services.

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A Category in Transformation

There is nevertheless value in creating clearer signposting.

Women planning pregnancy may have questions about supplementation, medicines, lifestyle and preconception health.

Breastfeeding support, postnatal nutrition, skincare, pain relief and maternal wellbeing can all form part of the pharmacy conversation.

Women who receive knowledgeable, sensitive and useful advice are more likely to return to the pharmacy when their needs change.

It is relationship building.

Ireland's evolving healthcare landscape is strengthening that position. State-funded HRT, contraception initiatives and the wider expansion of pharmacy services are placing community pharmacists increasingly at the heart of accessible healthcare. The commercial opportunity should therefore not be considered separately from the professional one.

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For Irish community pharmacy, the opportunity is particularly significant. National investment in women's health, increasing public awareness, free HRT, evolving contraception services and greater openness around previously underdiscussed conditions are changing both expectations and patterns of healthcare access. The pharmacies best placed to respond will be those that look beyond individual products and consider the whole women's health journey. That means appropriate product ranges, knowledgeable teams, confidential conversations, strong referral pathways and an understanding that women's health needs evolve continually throughout life. From menstrual and intimate health through contraception, fertility and pregnancy to menopause and healthy ageing, community pharmacy has an opportunity to become one of the most accessible and trusted destinations for women's healthcare in Ireland. And as consumers increasingly seek personalised solu tions appropriate to their age, lifestyle and life stage, women's health looks set to remain an increasingly important part of both the professional and commercial future of community pharmacy.

The Brands Leading Ireland's OTC Market The following pages place the spotlight on a selection of products featuring within the Top 25 of the 2026 Irish Pharmacy News Top 100 OTC Products, celebrating some of the brands demonstrating the strongest commercial performance within Irish community pharmacy. Drawn from the 2026 Top 100 Over-the-Counter (OTC) Market Report, the rankings are compiled using IQVIA's audited OTC data – an established industry benchmark for measuring brand and category performance across the sector. The data reflects wholesale sales of OTC products into Irish retail pharmacy over the 12-month period from May 2025 to April 2026, providing an important snapshot of the brands currently commanding consumer demand. While the rankings demonstrate the enduring strength of many established and trusted OTC names, they also provide a window into the changing priorities of today's consumer. Traditional areas such as pain relief and cough, cold and respiratory care remain central to the market, but the wider 2026 data also points towards increasing consumer engagement with self-care, prevention, digestive health, sleep, eye care, skin health and intimate wellbeing. Against a backdrop of increasingly considered consumer spending, securing a position within the Top 25 is a significant achievement. These are products succeeding in a competitive marketplace in which brand trust, efficacy, accessibility and relevance to everyday health needs remain critical. The products showcased across the following pages therefore represent more than commercial success alone. Collectively, they offer an insight into what Irish consumers are choosing, the health needs currently driving pharmacy purchases and the brands setting the benchmark within Ireland's evolving OTC market in 2026.

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Marketing Insight: Wellness

Wellness: The Category Transforming Community Pharmacy For many years, the over-the-counter (OTC) market was largely centred around treating illness. Patients visited the pharmacy because they had a cough, a headache, indigestion or hay fever, and the pharmacist's role was to recommend the most appropriate treatment. Today, that picture is changing. Consumers are no longer simply looking for products to treat symptoms – increasingly, they are looking for ways to stay well in the first place. Prevention, healthy ageing and long-term wellbeing have become major drivers of purchasing decisions, with consumers actively seeking advice on everything from gut health and immunity to sleep, stress, hydration and cognitive function. Recent Irish research suggests this shift is now mainstream, with more than half of adults taking supplements daily and the majority reporting they are taking proactive steps to support their future health. This evolution is creating one of the biggest opportunities community pharmacy has seen in years. Unlike many areas of retail, wellness is built on trust, education and personalised advice – strengths that have always been at the heart of pharmacy practice. As the market continues to expand, pharmacists and their teams are perfectly placed to help consumers

navigate an increasingly complex range of products while ensuring recommendations remain evidence-based and appropriate for individual patients. Wellness is No Longer a Niche Category

Importantly, wellness is no longer confined to one demographic.

The concept of wellness has evolved significantly over the past decade. Where consumers once viewed vitamins as something to take during winter or while recovering from illness, today's shopper is far more proactive. They are thinking about long-term health, healthy ageing, prevention and performance. Rather than waiting until they become unwell, many consumers are now investing in products that support their everyday wellbeing. This shift is evident across almost every area of pharmacy. Consumers are asking about probiotics to support digestive health, magnesium for muscle recovery and sleep, collagen

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for healthy skin and joints, electrolytes for hydration, omega-3 supplements for cardiovascular and cognitive health, vitamin D for bone health, and products designed to support energy, immunity and mental wellbeing.

Younger adults are increasingly interested in fitness, gut health and cognitive performance. Parents are seeking nutritional support for children, while older adults continue to prioritise bone health, mobility and healthy ageing. Women are also becoming increasingly proactive in managing hormonal health throughout different life stages, including pregnancy, perimenopause and menopause. The result is a category that continues to grow both in size and importance within community pharmacy. Rising health awareness, greater acceptance of self-care and national healthcare strategies promoting prevention are all helping to fuel demand.

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Gut Health Continues to Dominate Few wellness categories have experienced as much growth as digestive health. Over recent years, consumers have become increasingly aware of the relationship between the gut microbiome and overall wellbeing. Scientific research continues to explore links between gut health, immunity, metabolism and mental wellbeing, helping to drive consumer interest. While social media has undoubtedly accelerated awareness, pharmacy teams have an important role in separating emerging evidence from marketing hype. Consumers frequently ask whether they should be taking probiotics, which strain to choose, whether prebiotics are necessary, and how long supplementation should continue. These conversations provide valuable opportunities to educate patients about realistic expectations while ensuring products are selected appropriately.

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Marketing Insight: Wellness

The emergence of probiotic brands within the IQVIA Top 100 reflects this growing interest and reinforces digestive wellness as one of pharmacy's fastestgrowing categories. Healthy Ageing is Becoming Mainstream Ireland's ageing population is also reshaping the wellness market. Consumers are no longer waiting until later life to think about bone strength, cognitive health or maintaining mobility. Instead, healthy ageing has become a preventative strategy. Vitamin D and calcium remain among the most established recommendations, particularly for older adults at risk of osteoporosis. At the same time, consumers increasingly enquire about magnesium, omega-3 fatty acids, collagen products, joint supplements and products marketed to support memory and concentration. These conversations often provide pharmacists with an opportunity to identify wider healthcare needs. A patient asking about memory supplements may benefit from medication review or referral if cognitive changes are concerning. Someone requesting joint supplements may also benefit from lifestyle advice around weight management or exercise. Wellness therefore becomes not simply about product recommendation, but about initiating meaningful healthcare conversations. Sleep and Stress Continue to Drive Demand Modern lifestyles continue to fuel growing demand for sleep and stress support. Long working hours, financial pressures, increased screen time and changing work patterns have all contributed to greater consumer awareness of mental wellbeing. Many consumers now seek alternatives before considering prescription medicines. Magnesium supplements, herbal sleep aids, lavender preparations and products designed to support relaxation have all become increasingly common purchases. However, pharmacists remain uniquely positioned to identify when

symptoms may reflect underlying anxiety, depression, medication side effects or other medical conditions requiring referral. While consumers often arrive seeking "something natural", effective pharmacy care involves understanding the wider picture before making recommendations. The pharmacy team's ability to combine empathy with clinical assessment remains one of its greatest strengths. Hydration and Functional Nutrition Hydration has become another rapidly expanding area within wellness. Historically associated primarily with sports nutrition, electrolyte products are now being purchased for a much broader range of reasons. Consumers use them during illness, travel, exercise, hot weather and recovery from gastrointestinal conditions. The growing popularity of hydration products reflects a broader shift towards functional nutrition—products that provide a specific health benefit beyond basic nutrition. Consumers increasingly understand that hydration is about more than simply drinking water. Community pharmacy is well placed to advise on when electrolyte replacement is appropriate, identify patients at higher risk of dehydration and reinforce the importance of oral rehydration therapy in vulnerable groups such as young children and older adults. Digital Information Brings New Challenges One of the biggest changes affecting the wellness category is the way consumers access information.

potential interactions or whether the product is suitable for their individual circumstances. Pharmacists therefore have an increasingly important role as evidence-based advisors. Rather than dismissing trends outright, successful pharmacy teams acknowledge consumer interest while helping patients interpret the available evidence and make informed decisions. This approach strengthens trust while reinforcing pharmacy's role as the most accessible healthcare destination for reliable advice.

A request for vitamin D may prompt wider conversations about bone health or falls prevention. These interactions help position community pharmacy as a destination for holistic health advice rather than simply product supply. Looking Ahead

Perhaps the biggest opportunity within wellness is personalisation.

Consumers increasingly expect healthcare recommendations tailored to their age, lifestyle, health goals and medical history.

Unlike prescription medicines, wellness products often require discussion before recommendation. Two patients asking for an immune support supplement may have completely different needs depending on their age, medical history, medications and lifestyle. Similarly, someone requesting probiotics following antibiotic treatment requires different advice to a patient seeking long-term digestive support. This personalised approach represents one of community pharmacy's greatest competitive advantages over online retailers and supermarkets. Consumers are increasingly looking for reassurance that they are spending money on products that genuinely meet their needs rather than simply purchasing the latest trend. Opportunities for the Entire Pharmacy Team The wellness category is not solely the responsibility of the pharmacist.

While this has undoubtedly increased engagement with personal health, it has also created significant confusion.

Ensuring the wider pharmacy team receives regular product education is therefore essential.

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Questions about magnesium may open discussions around sleep hygiene.

The future of wellness is likely to become even more personalised.

Pharmacy technicians, medicines counter assistants and healthcare advisors are often the first point of contact for customers browsing vitamins and supplements.

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A conversation about probiotics may naturally lead to dietary advice.

The Importance of Personalisation

Patients frequently arrive having researched products online, watched social media videos or followed influencer recommendations.

Consumers may arrive requesting products they have seen promoted without understanding the supporting evidence,

Cross-category knowledge is becoming increasingly valuable.

Confident staff can identify opportunities for appropriate conversations while recognising situations that require pharmacist involvement.

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At the same time, community pharmacy itself continues to evolve. National initiatives are expanding the profession's clinical role, reinforcing pharmacies as accessible health hubs that support prevention alongside treatment. For pharmacy teams, this creates both opportunity and responsibility. Opportunity because wellness categories continue to expand and diversify, attracting consumers seeking trusted guidance rather than simply products. Responsibility because the volume of information available online means patients increasingly rely on pharmacists to interpret evidence, challenge misinformation and recommend products appropriately. Ultimately, the wellness market is about far more than vitamins and supplements. It represents a fundamental shift in the way people think about their health. Consumers are becoming more proactive, more engaged and more willing to invest in prevention than ever before. For community pharmacy, that trend aligns perfectly with the profession's strengths. As the healthcare landscape continues to move towards prevention, early intervention and self-care, pharmacists and their teams have an increasingly important role—not simply helping people recover from illness, but helping them stay well for longer.

READY FOR HAYFEVER SEASON? FAST RELIEF OF ALLERGIES 24hr CONTROL Always read the leaﬂet. Abbreviated prescribing information

WƌŽĚƵĐƚ EĂŵĞ͗ ĞƚƌŝŶĞ ůůĞƌŐǇ ϭϬŵŐ &ŝůŵͲĐŽĂƚĞĚ dĂďůĞƚƐ͘ ŽŵƉŽƐŝƚŝŽŶ͗ ĂĐŚ ƚĂďůĞƚ ĐŽŶƚĂŝŶƐ ϭϬŵŐ ĐĞƚŝƌŝǌŝŶĞ ĚŝŚǇĚƌŽĐŚůŽƌŝĚĞ͘ ĞƐĐƌŝƉƚŝŽŶ͗ tŚŝƚĞ͕ ŽďůŽŶŐ ĨŝůŵͲĐŽĂƚĞĚ ƚĂďůĞƚƐ͕ ƐĐŽƌĞĚ ŽŶ ŽŶĞ ƐŝĚĞ͘ ĂŶ ďĞ ĚŝǀŝĚĞĚ ŝŶƚŽ ĞƋƵĂů ŚĂůǀĞƐ͘ /ŶĚŝĐĂƚŝŽŶ;ƐͿ͗ ĚƵůƚƐ ĂŶĚ ƉĂĞĚŝĂƚƌŝĐ ƉĂƚŝĞŶƚƐ ϲ ǇĞĂƌƐ ĂŶĚ ĂďŽǀĞ͗ ZĞůŝĞĨ ŽĨ ŶĂƐĂů ĂŶĚ ŽĐƵůĂƌ ƐǇŵƉƚŽŵƐ ŽĨ ƐĞĂƐŽŶĂů ĂŶĚ ƉĞƌĞŶŶŝĂů ĂůůĞƌŐŝĐ ƌŚŝŶŝƚŝƐ ;ŚĂǇ ĨĞǀĞƌͿ͖ ƌĞůŝĞĨ ŽĨ ƐǇŵƉƚŽŵƐ ŽĨ ĐŚƌŽŶŝĐ ŝĚŝŽƉĂƚŚŝĐ ƵƌƚŝĐĂƌŝĂ͘ ŽƐĂŐĞ͗ ĚƵůƚƐ͕ ĞůĚĞƌůǇ ĂŶĚ ĐŚŝůĚƌĞŶ ĂŐĞĚ ϭϮ ǇĞĂƌƐ ĂŶĚ ŽǀĞƌ͗ ϭϬŵŐ ŽŶĐĞ ĚĂŝůǇ͘ ŚŝůĚƌĞŶ ĨƌŽŵ ϲ ǇĞĂƌƐ ƚŽ ϭϮ ǇĞĂƌƐ͗ ϱŵŐ ;ŚĂůĨ Ă ƚĂďůĞƚͿ ƚǁŝĐĞ ĚĂŝůǇ͘ DŽĚĞƌĂƚĞ ƌĞŶĂů ŝŶƐƵĨĨŝĐŝĞŶĐǇ ;ĐƌĞĂƚŝŶŝŶĞ ĐůĞĂƌĂŶĐĞ ƌ ů ϯϬͲϰϵŵůͬŵŝŶͿ͗ ϱŵŐ ŽŶĐĞ ĚĂŝůǇ͘ ^ĞǀĞƌĞ ƌĞŶĂů ŝŶƐƵĨĨŝĐŝĞŶĐǇ ;ĐƌĞĂƚŝŶŝŶĞ ĐůĞĂƌĂŶĐĞ фϯϬŵůͬŵŝŶͿ͗ ϱŵŐ ŽŶĐĞ ĞǀĞƌǇ Ϯ ĚĂǇƐ͘ ŚŝůĚƌĞŶ ƵŶĚĞƌ ϲ ǇĞĂƌƐ͗ EŽƚ ƌĞĐŽŵŵĞŶĚĞĚ͘ ŽŶƚƌĂŝŶĚŝĐĂƚŝŽŶƐ͗ ,ŝƐƚŽƌǇ ŽĨ ŚǇƉĞƌƐĞŶƐŝƚŝǀŝƚǇ ƚŽ ƚŚĞ ĂĐƚŝǀĞ ƐƵďƐƚĂŶĐĞ͕ ƚŽ ĂŶǇ ŽĨ ƚŚĞ ĞǆĐŝƉŝĞŶƚƐ ŝŶ ƚŚĞ ƚĂďůĞƚ͕ ƉŝƉĞƌĂǌŝŶĞ ĚĞƌŝǀĂƚŝǀĞƐ Žƌ ŚǇĚƌŽǆǇǌŝŶĞ͘ ŶĚ ƐƚĂŐĞ ƌĞŶĂů ŝŵƉĂŝƌŵĞŶƚ ǁŝƚŚ ƐƚŝŵĂƚĞĚ 'ůŽŵĞƌƵůĂƌ &ŝůƚƌĂƚŝŽŶ ZĂƚĞ ф ϭϬŵůͬŵŝŶ͘ tĂƌŶŝŶŐƐ ĂŶĚ WƌĞĐĂƵƚŝŽŶƐ ĨŽƌ hƐĞ͗ ZĞĚƵĐĞ ĚŽƐĂŐĞ ŝŶ ƉĂƚŝĞŶƚƐ ǁŝƚŚ ƐŝŐŶŝĨŝĐĂŶƚ ƌĞŶĂů ŝŵƉĂŝƌŵĞŶƚ͘ ĞƚŝƌŝǌŝŶĞ ŵĂǇ ŝŶĐƌĞĂƐĞ ƌŝƐŬ ŽĨ ƵƌŝŶĂƌǇ ƌĞƚĞŶƚŝŽŶ͕ ƚŚĞƌĞĨŽƌĞ ĐĂƵƚŝŽŶ ŝŶ ƉĂƚŝĞŶƚƐ ǁŝƚŚ ƉƌĞĚŝƐƉŽƐŝƚŝŽŶ ĨĂĐƚŽƌƐ ŽĨ ƵƌŝŶĂƌǇ ƌĞƚĞŶƚŝŽŶ ;Ğ͘Ő͘ ƐƉŝŶĂů ĐŽƌĚ ůĞƐŝŽŶ͕ ƉƌŽƐƚĂƚŝĐ ŚǇƉĞƌƉůĂƐŝĂͿ͘ ĂƵƚŝŽŶ ŝŶ ĞƉŝůĞƉƚŝĐ ƉĂƚŝĞŶƚƐ ĂŶĚ ƉĂƚŝĞŶƚƐ Ăƚ ƌŝƐŬ ŽĨ ĐŽŶǀƵůƐŝŽŶƐ͘ ŽŶƚĂŝŶƐ ůĂĐƚŽƐĞ͘ ŝƐĐŽŶƚŝŶƵĞ ƵƐĞ ŽĨ ĐĞƚŝƌŝǌŝŶĞ ƚŚƌĞĞ ĚĂǇƐ ďĞĨŽƌĞ ĂůůĞƌŐǇ ƚĞƐƚŝŶŐ͘ WƌƵƌŝƚŝƐ ĂŶĚͬŽƌ ƵƌƚŝĐĂƌŝĂ ŵĂǇ ŽĐĐƵƌ ǁŚĞŶ ĐĞƚŝƌŝǌŝŶĞ ŝƐ ƐƚŽƉƉĞĚ͕ ĞǀĞŶ ŝĨ ƚŚĞ ƐǇŵƉƚŽŵƐ ǁĞƌĞ ŶŽƚ ƉƌĞƐĞŶƚ ďĞĨŽƌĞ ƚƌĞĂƚŵĞŶƚ ŝŶŝƚŝĂƚŝŽŶ͘ ^ǇŵƉƚŽŵƐ ŵĂǇ ďĞ ŝŶƚĞŶƐĞ ĂŶĚ ŵĂǇ ƌĞƋƵŝƌĞ ƚƌĞĂƚŵĞŶƚ ƚŽ ƐƚĂƌƚ ĂŐĂŝŶ ;ƐŚŽƵůĚ ƚŚĞŶ ƌĞƐŽůǀĞͿ͘ ŽŶƚĂŝŶƐ ůĂĐƚŽƐĞ͘ /ŶƚĞƌĂĐƚŝŽŶƐ͗ ĂƵƚŝŽŶ ŝƐ ĂĚǀŝƐĞĚ ǁŚĞŶ ƚĂŬĞŶ ĐŽŶĐŽŵŝƚĂŶƚůǇ ǁŝƚŚ ĂůĐŽŚŽů Žƌ ŽƚŚĞƌ E^ ĚĞƉƌĞƐƐĂŶƚƐ͘ ĞƚŝƌŝǌŝŶĞ ĚŽĞƐ ŶŽƚ ƉŽƚĞŶƚŝĂƚĞ ƚŚĞ ĞĨĨĞĐƚ ŽĨ ĂůĐŽŚŽů ;Ϭ͘ϱŐͬů ďůŽŽĚ ůĞǀĞůƐͿ͘ WƌĞŐŶĂŶĐǇ ĂŶĚ >ĂĐƚĂƚŝŽŶ͗ ĂƵƚŝŽŶ ĚƵƌŝŶŐ ƉƌĞŐŶĂŶĐǇ ĂŶĚ ďƌĞĂƐƚͲĨĞĞĚŝŶŐ͘ ďŝůŝƚǇ ƚŽ ƌŝǀĞ ĂŶĚ hƐĞ DĂĐŚŝŶĞƌǇ͗ hƐƵĂůůǇ ŶŽŶͲƐĞĚĂƚŝǀĞ͕ ƉĂƚŝĞŶƚƐ ƐŚŽƵůĚ ƚĂŬĞ ƚŚĞŝƌ ƌĞƐƉŽŶƐĞ ƚŽ ƚŚĞ ƉƌŽĚƵĐƚ ŝŶƚŽ ĂĐĐŽƵŶƚ͘ hŶĚĞƐŝƌĂďůĞ ĨĨĞĐƚƐ͗ ĞƚŝƌŝǌŝŶĞ Ăƚ ƚŚĞ ƌĞĐŽŵŵĞŶĚĞĚ ĚŽƐĂŐĞ ŚĂƐ ŵŝŶŽƌ ĂĚǀĞƌƐĞ ĞĨĨĞĐƚƐ ŽŶ ƚŚĞ E^͕ ŝŶĐůƵĚŝŶŐ ƐŽŵŶŽůĞŶĐĞ͕ ĨĂƚŝŐƵĞ͕ ĚŝǌǌŝŶĞƐƐ ĂŶĚ ŚĞĂĚĂĐŚĞ͘ /Ŷ ƐŽŵĞ ĐĂƐĞƐ͕ ƉĂƌĂĚŽǆŝĐĂů E^ ƐƚŝŵƵůĂƚŝŽŶ ŚĂƐ ďĞĞŶ ƌĞƉŽƌƚĞĚ͘ /ŶƐƚĂŶĐĞƐ ŽĨ ĂďŶŽƌŵĂů ŚĞƉĂƚŝĐ ĨƵŶĐƚŝŽŶ ǁŝƚŚ ĞůĞǀĂƚĞĚ ŚĞƉĂƚŝĐ ĞŶǌǇŵĞƐ ĂĐĐŽŵƉĂŶŝĞĚ ďǇ ĞůĞǀĂƚĞĚ ďŝůŝƌƵďŝŶ ŚĂǀĞ ďĞĞŶ ƌĞƉŽƌƚĞĚ ǁŚŝĐŚ ƌĞƐŽůǀĞƐ ŽŶ ĚŝƐĐŽŶƚŝŶƵĂƚŝŽŶ ŽĨ ƚŚĞ ĚƌƵŐ͘ hŶĐŽŵŵŽŶ͗ ŐŝƚĂƚŝŽŶ͕ ĚŝĂƌƌŚŽĞĂ͕ ƉƌƵƌŝƚƵƐ͕ ƌĂƐŚ͕ ĂƐƚŚĞŶŝĂ͕ ŵĂůĂŝƐĞ͕ ƉĂƌĂĞƐƚŚĞƐŝĂ͘ ^ĞĞ ^W ĨŽƌ Ăůů ĂĚǀĞƌƐĞ ƌĞĂĐƚŝŽŶƐ͘ DĂƌŬĞƚŝŶŐ ƵƚŚŽƌŝƐĂƚŝŽŶ ,ŽůĚĞƌ͗ ZŽǁĞǆ >ƚĚ͕ ĂŶƚƌǇ͕ Ž͘ ŽƌŬ͘ DĂƌŬĞƚŝŶŐ ƵƚŚŽƌŝƐĂƚŝŽŶ EƵŵďĞƌ͗ W ϬϳϭϭͬϬϳϱͬϬϬϮ͘ &ƵƌƚŚĞƌ ŝŶĨŽƌŵĂƚŝŽŶ ĂŶĚ ^W ĂƌĞ ĂǀĂŝůĂďůĞ ĨƌŽŵ͗ ZŽǁĞǆ >ƚĚ͕ ĂŶƚƌǇ͕ Ž͘ ŽƌŬ͘ &ƌĞĞƉŚŽŶĞ͗ ϭϴϬϬ ϴϯ ϮϬ ϴϯ ͲŵĂŝů͗ ŵŝ͘ŝƌĞůĂŶĚΛƐĂŶĚŽǌ͘ŶĞƚ >ĞŐĂů ĂƚĞŐŽƌǇ͗ EŽƚ ƐƵďũĞĐƚ ƚŽ ŵĞĚŝĐĂů ƉƌĞƐĐƌŝƉƚŝŽŶ͘ ĂƚĞ ŽĨ WƌĞƉĂƌĂƚŝŽŶ͗ DĂƌĐŚ ϮϬϮϲ MLR ID for API: MLR-0129-IE

Date of preparation: (03/2026) MLR ID: MLR-0128-IE

Supply status: Supply through pharmacies only

Marketing Insight: Allergies

Allergy: A high-margin category with increased product pairing potential Written by Frances Boylan, OTC Buyer at Navi Group Allergy is one of the key seasonal categories in pharmacy, but it does not generate the same footfall spikes as cough and cold. With an average cash margin of 61%, allergy is one of the more profitable categories on the OTC shelf. It is a category that is being maintained rather than developed, and one where a modest shift in range, placement or staff engagement could unlock potential. Allergy is a high-margin, weatherdriven category that peaks in warm conditions. This was clear when the weather was warmer in June 2026. EPOS sales rose by 47% in June 2026 versus June 2025, compared with 8% growth in April and May. It is important that staff are aware of this peak and ensure products are adequately stocked and placed in key locations in store. Core category products such as cetirizine rose 37% in June 2026 versus June 2025. The secondgeneration oral antihistamine fexofenadine increased by 64% in June 2026 versus June 2025, driven by a 51% rise in the brand Telfast and 13% in generic variants. Steroid nasal sprays increased by between 42% and 100%, and eye drops also moved into double-digit growth. Why allergy matters at the counter Allergic conditions don't follow the calendar the way many people assume. Hay fever is the most visible driver of footfall, but allergic reactions to dust, pets, mould, certain foods, and skin irritants occur all year round. This means allergy is not a seasonal category that pharmacies can staff up for in April and forget about by September; it's a category that needs a baseline of confident advice and adequate stock levels every week of the year. Patients also behave differently with allergy symptoms than they do with many other conditions. Sneezing, itchy eyes, a blocked nose or a patch of irritated skin are the kind of symptoms people are comfortable walking into a pharmacy and asking about before they try to get a GP appointment. That gives community pharmacy a genuine first-line advantage but only if the staff behind the counter are equipped to have that conversation confidently and are aware of the full range of products that could help, rather than

reaching for the single SKU they know best. This is where the growth opportunity arises. Trained staff build patient trust and loyalty. This opens the door to product pairing and to linking the OTC conversation with the dispensary, increasing basket size and overall transaction value. At Navi Group, conditionbased product knowledge training is key for all OTC pharmacy staff across our network. Understanding the core conditions Hay fever (seasonal allergic rhinitis) remains the best-known and most common allergic condition pharmacy teams will encounter. It occurs when the immune system misidentifies airborne pollen from trees, grasses, weeds and flowers as a harmful substance, triggering the release of histamine. That histamine response causes inflammation in the nose, eyes and throat, producing the classic symptom cluster: sneezing, a runny or blocked nose, an itchy or scratchy throat, and watery, irritated eyes. Allergic conjunctivitis: A patient buying a tablet for sneezing but still rubbing their eyes is a clear product pairing cue to recommend drops to ease the symptoms. Skin-related allergic reactions: Contact dermatitis, hives, and general skin irritation represent a category that is easy to overlook but sits naturally alongside the allergy fixture. Topical hydrocortisone, antihistamine creams and emollients all have a role here, and skin symptoms are a good prompt to ask whether a patient is also experiencing any nasal or eye symptoms, and vice versa. Building confidence at the counter Allergy is a category where patients frequently arrive with

vague or overlapping symptoms and are open to guidance, but if staff default to whichever product they're most familiar with, the conversation stops there. Training that covers the full symptom picture (nasal, eye, skin, and general hay fever symptoms) equips staff to ask one or two additional questions that reveal whether a patient's needs extend beyond what they originally asked for. This is also where the dispensary link becomes valuable. Patients collecting prescriptions for unrelated conditions may mention allergy symptoms in passing or may be on medications where an OTC antihistamine interaction is worth flagging. A pharmacist or technician who is comfortable making that connection turns a routine prescription collection into an additional, high-margin basket item. Where the growth opportunity sits A flat category against the prior year does not necessarily mean flat demand; it more often points to a range or merchandising opportunity. OTC Teams should look specifically at: • Complementary SKUs alongside top sellers If oral antihistamines dominate current sales, eye drops, nasal sprays and barrier balms are natural, lower-friction additions that can be recommended in the same conversation. • Cross-merchandising with skin and eye care Positioning allergy-relevant skin and eye products near the core allergy fixture, rather than solely in general skincare or eye care sections, can prompt the product pairing opportunity that drives up average transaction value.

• Margin maximisation It's worth stating plainly what the 61% average cash margin means in practical terms: Allergy is one of the more profitable ways to grow basket value in the OTC space, more so than many higherfootfall categories. Making the case internally In peak season, additional shelf space, a training refresh, or a promotional slot are imperative. Unlike categories where growth requires chasing an emerging trend or a new consumer habit, allergy growth is largely about execution against existing, stable demand. The patients are already coming into the pharmacy; the pollen counts, dust mites and pet allergens aren't going anywhere. The opportunity lies in how that demand is being met: through a single reflexive product recommendation or a fuller conversation that captures the eye, skin and nasal symptoms a patient may not have mentioned unprompted. That represents a relatively low-cost opportunity compared with categories that require new listings or committed promotional spend to move the needle. A short staff briefing on cross-symptom questioning could be paired with a review of whether changes to the fixture layout can be tested and measured within a single pollen season. Allergy is a category built on steady, year-round patient need, high trust in pharmacy advice and strong margins, three factors that, taken together, make it one of the more reliable areas in which to invest in staff training and range development. The groundwork is broader product awareness and confident link-selling conversations. Allergy is a strong candidate hiding in plain sight.

BACK TO SCHOOL WITH TEEN

Scientifically studied, easy to take and designed to fit effortlessly into everyday routines.

Up to 24-Hour Hayfever Control1 Zirtek Allergy Relief Tablets and Zirtek Oral Solution improve quality of life for individuals with seasonal or perennial allergic rhinitis.2 They provide proven, year-round allergy relief and are non-drowsy in most people.1,2 Zirtek Plus Decongestant combines antihistamine with an added decongestant. Help your customers take control with Plus Decongestant, stay in control with Allergy Relief Tablets, and there’s relief for the little ones with Oral Solution (2yrs+)2.

Boost your campaigns this allergy season with Zirtek A great range of products from 2 years to adult2 Up to 24 hour allergy symptom relief1 Available in extra-value packs and travel sizes High-profile marketing support, including online advertising and social media

Orders and Further Information Alice Dwyer: 085 8817729 | alice.dwyer@uniphar.com Ger Allen: 087 2958103 | ger.allen@uniphar.com Gary Lydon: 085 8716855 | gary.lydon@uniphar.com www.zirtek.ie @ZirtekIE

IE-ZI-2600018

Eye-catching point-of-sales material; contact your local agent below

References available upon request. Date of prep April 2026. Further information is available on request from UCB Pharma (Ireland) Ltd, United Drug House, Magna Drive, Citywest Road, Dublin 24. Zirtek Allergy Relief Tablets and Zirtek Oral Solution (cetirizine dihydrochloride) Active Ingredients: Cetirizine dihydrochloride Tablets: 10 mg; Oral solution: 1 mg/ml. Indications: Relief of nasal and ocular symptoms of seasonal and perennial allergic rhinitis. For the relief of symptoms of Chronic idiopathic urticaria. Dosage and Administration: Adults and over 12 years: 10 mg once daily. Children aged 6 to 12 years: 5 mg twice daily. Children aged 2 to 6 years: Oral solution only - 2.5 mg twice daily. Reduce dose in moderate or severe renal impairment – see SmPC. Contraindications: Hypersensitivity to active ingredients or excipients, hydroxyzine, or piperazine derivatives. End stage renal disease. Warnings and Precautions: Caution in epilepsy, risk of convulsions, predisposition factors of urinary retention and with alcohol. Allergy skin tests are inhibited. Rebound pruritus and/or urticaria may occur. Tablets: galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption. Oral solution: Fructose intolerance. Interactions: Concurrent alcohol and CNS depressants may reduce alertness. Pregnancy/Lactation: Caution. Driving etc: Patients experiencing somnolence should refrain from driving, potentially hazardous activities or operating hazardous machinery. Adverse Effects: Uncommon: agitation, paraesthesia, diarrhoea, pruritus, rash, asthenia, malaise. Rare: hypersensitivity, aggression, confusion, depression, hallucination, insomnia, convulsions, tachycardia, abnormal hepatic function, urticaria, oedema, increased weight. Very rare: thrombocytopenia, anaphylactic shock, tics, dysgeusia, syncope, tremor, dystonia, dyskinesia, accommodation disorder, blurred vision, oculogyric crisis, angioneurotic oedema, fixed drug eruption, dysuria, enuresis. Not known: increased appetite, suicidal ideation, nightmare, amnesia, memory impairment, vertigo, hepatitis, acute generalized exanthematous pustulosis, arthralgia, myalgia, urinary retention. Pruritis and/or urticaria following discontinuation. See SmPC for adverse effects reporting in clinical studies. Legal Category: Supply through Pharmacy only. MA Numbers: Tablets: PA 0891/008/005. Oral solution: PA 0891/008/003. Further information is available from MA Holder: UCB Pharma (Ireland) Ltd, United Drug House, Magna Drive, Citywest Road, Dublin 24, Ireland. Medical Information: (+353) 01 463 2371 Email: ucbcares.ie@ucb.com. Date of Revision: October 2023 (IE-P-ZI-ALY-2300012). Zirtek is a registered trademark. Zirtek Plus Decongestant Prolonged Release Tablets (cetirizine dihydrochloride and pseudoephedrine hydrochloride) Active Ingredients: 5 mg cetirizine dihydrochloride and 120 mg pseudoephedrine hydrochloride. Indications: Treatment of symptoms such as nasal congestion, sneezing, rhinorrhoea and nasal and ocular pruritus associated with seasonal or perennial allergic rhinitis. Use when anti-allergy and nasal decongestant activity desired. Dosage and Administration: Adults and adolescents over 12 years: one tablet twice daily for up to 2-3 weeks. After disappearance of nasal symptoms, continue antihistamine alone. Moderate renal/hepatic insufficiency: one tablet daily. Contraindications: Hypersensitivity to active ingredients or excipients, ephedrine or piperazine. Hypertension, ischaemic heart disease, end stage renal disease, uncontrolled hyperthyroidism, severe arrhythmias, pheochromocytoma, elevated intraocular pressure, urinary retention, concurrent antihypertensives (such as beta-blockers, sympathomimetics, dihydroergotamine or amphetamines), concurrent monoamine oxidase inhibitors (and up to 2 weeks after their discontinuation), concurrent vasoconstrictors or other decongestants history of stroke or increased risk of haemorrhagic stroke. Under 12 years of age. Warnings and Precautions: Not with galactose intolerance, total lactase deficiency or glucose-galactose malabsorption. Caution with concurrent sympathomimetics, tricyclic antidepressants, linezolid, guanethidine, reserpine, phenothiazines, antihypertensives and cardiac glycosides. Caution in diabetes mellitus, hyperthyroidism, tachycardia, cardiac arrhythmia, angina, moderate hepatic or renal insufficiency, use with alcohol or other central nervous system depressants, a history of, or at high risk of stroke, at risk for hypercoagulability as in inflammatory bowel disease, hypertensive patients on non-steroidal anti-inflammatory drugs, patients over 50 years and the elderly. May increase risk of urinary retention. May cause insomnia, nervousness, hyperpyrexia, tremor, epileptiform convulsions. Cases of pseudoephedrine abuse observed. Ischaemic colitis and ischaemic optic neuropathy have been reported. Discontinue and seek medical advice if sudden abdominal pain, rectal bleeding or other symptoms of ischaemic colitis develop or sudden loss of vision or visual acuity. Severe skin reactions may occur so monitor for signs and symptoms (e.g pyrexia, erythema or small pustules) and discontinue if observed. Can cause positive doping results. Have wash-out period before allergy skin tests. Interactions: See above and SmPC for detail. Pregnancy/Lactation: Not recommended. Driving etc: Patients experiencing somnolence should refrain from driving, potentially hazardous activities or operating machinery. Adverse Effects: Common: nervousness, insomnia, vertigo, dizziness, headache, drowsiness, tachycardia, dry mouth, nausea, asthenia. Uncommon: agitation, anxiety. Rare: hypersensitivity (including anaphylactic shock), hallucinations, convulsions, tremor, arrhythmia, pallor, arterial hypertension, vomiting, abnormal hepatic function, dry skin, rash, increased sweating, urticaria, dysuria. Very rare: psychotic disorder, dysgeusia, cerebrovascular accident, circulatory collapse, angioneurotic oedema, fixed drug eruption. Not known: aggression, confusional state, depression, tic, euphoric mood, suicidal ideation, paraesthesia, restlessness, dystonia, dyskinesia, amnesia, memory impairment, syncope, accommodation disorder, blurred vision, mydriasis, eye pain, visual impairment, photophobia, oculogyric crisis, ischaemic optic neuropathy, palpitations, dyspnoea, ischaemic colitis, diarrhoea, abdominal discomfort, acute generalised exanthematous pustulosis, pruritus, arthralgia, myalgia, urinary retention, enuresis, erectile dysfunction, oedema, malaise. Isolated cases of hepatitis reported. Pruritis following discontinuation. Legal Category: Supply through Pharmacy only. MA Number: PA 0891/008/001 Further information is available from MA Holder: UCB Pharma (Ireland) Ltd, United Drug House, Magna Drive, Citywest Road, Dublin 24, Ireland. Medical Information: (+353) 01 463 2371 UCBCares.IE@ ucb.com. Date of Revision: November 2021 (IE-P-ZI-ALY-2100058). Zirtek is a registered trademark. Adverse events should be reported. Reporting forms and information can be found at https://www.hpra.ie/homepage/about-us/report-an-issue for Republic of Ireland. Adverse events should also be reported to UCB (Pharma) Ireland Ltd at ucbcares.ie@ucb.com or 1800 930075 for Republic of Ireland.

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Key Trends in Irish Community Pharmacy Summary Q2 2026

Revenue Pulse

Electronic Record Keeping The below is a summary of the latest analysis of the key

Value of sales

Fitzgerald Power regularly update community pharmacy across Ireland as to the latest trends affecting the sector. Pharmacy Pulse provides an analysis of the key trends in the Irish Community Pharmacy sector, prepared by Fitzgerald Power in partnership with the Irish Pharmacy Union on a quarterly basis.

trends in the Irish Community Pharmacyrecord sector, prepared on a New legislation has provided for electronic keeping The value of pharmaceutical sales, as measured by the CSO, quarterly basis. for community pharmacies. The changes allow prescriptions increased by 5.5% in value in June 2026 against the same period transmitted electronically and a range of pharmacy records last year. to be stored digitally, this should ultimately lead to a reduction in administrative burden, improved workflow Value of Sales: CSO 5.5% efficiency and isRecord fully aligned to the- wider digitalisation Electronic Keeping New legislation hasofprovided SOURCE: CSO for electronic record keeping for community pharmacies. healthcare services in Ireland. The changes allow prescriptions transmitted electronically and a range of pharmacy records to be stored digitally, this should ultimately lead to a reduction in administrative burden, IQVIA dataOTC shows OTC are classes are up value IQVIA data shows classes up 0.6% in0.6% valueinand up and 3.4%up 3.4% in improved workflow efficiency and is fully aligned to the wider year. in volume, as against the same period last year. digitalisation of healthcare services in Ireland. IQVIA data shows RX classes are up 9.7% in value and 5.4% in The Government published the Health (Provision of Pharmacist-Led Contraception Service - The Government Top O Top OTC by Growth volume as against theClasses same period last year. Contraception Prescribing Service in Retail Pharmacy 10 published the Health (Provision of Contraception Prescribing Businesses) 2026Pharmacy in June. The legislationBill will2026 allowin June. Service inBillRetail Businesses) 8 Classes by Growth Top RX pharmacists to provide repeatpharmacists prescriptions certain The legislation will allow to for provide repeat prescriptions for certain contraceptive medicines directly to 30 contraceptive medicines directly to eligible patients, 6 eligibleaccess patients, access to women’s healthcare while improving to improving women’s healthcare while further 4 further expanding the clinical role of community pharmacists 25 expanding the clinical role of community pharmacists within within primary care. 2 primary care. 20 EU E-Commerce Import Charges - From 1st July 2026, the 0 European Union will introduce a new €3 customs charge on 15 -2 low-value imports from outside the EU. The reform aims to address concerns around unfair competition from international Pain R 10 Skin Treatment 8.67% e-commerce platforms by removing favourable customs From 1st July 2026, the European Union will introduce a Digestive Remedies 8.07% VMS forcharge low-value goods. The changefrom could benefit newtreatment €3 customs on low-value imports outside 5 Others 5.29% Diges community pharmacies and other Irish retailers by narrowing VMS & Tonics 4.30% the EU. The reform aims to address concerns around unfair Skin T the price gap between products sourced from overseas and 0 competition international e-commerce platforms IQVIA data shows OTC classes are up 0.6% in value and up 3.4% in volume, as against the same period last those soldfrom through local businesses. SOURCE: IQVIA SOURCE: I year.treatment for low-value by removing favourable customs Inflation and Cost of Living - Cost-of-living pressures Dermatology 27.4% goods. The change couldfor benefit community during pharmacies2026. remained a key issue Irish Top households AntiTop Diabetics 22.7%by Value OTC Classes OTC Classes byQ2 Growth andConsumer other Irishprices retailers by3.4% narrowing the price2026 gap between were higher in June than a year 10 GU 17.3% products from overseas sold through earlier,sourced with housing, electricity,and gas,those and other utility costs Oncology & Immunomodulators 11.8% 8 among the largest contributors to inflation. Rising living local businesses. Energy, wages and IT infrastructure 21.1% Cardiovascular System 10.8% 26.4% remain the areas in Q2 2026 whe expenses continued to impact 6household disposable income and substantial cost increases. IT expenditure is likely to remain significan SOURCE: IQVIA consumer spending, creating a challenging environment for both integration and changes in healthcare infrastructure as outlined in th 6.1% consumers and businesses. 4

Summary

Pharmacist-Led Contraception Service

OTC Tracker

Rx Tracker

EU E-Commerce Import Charges

OTC Tracker

Cost Pulse

Inflation and Cost of Living

2a key Uncertainty Cost-of-living remained issue for Irish- Global US Tradepressures Tariffs and Economic economic uncertainty remained Q2 2026 as 0 elevated households during Q2 2026. Consumer pricesduring were 3.4% businesses and policymakers continued to assess higher in June 2026 than a year earlier, with housing, the impact -2 of tariff-related trade tensions and geopolitical instability. electricity, gas, and other utility costs among the largest With Ireland’s economy heavilySkin dependent on international Treatment 8.67% contributors inflation. Rising living expenses continued trade and to foreign direct investment, concerns Digestive Remedies persisted 8.07% Others 5.29% to impact household disposable income and consumer regarding the potential impact on exports, business investment VMS & Tonics 4.30% and economic spending, creating growth. a challenging environment for both consumers and businesses. SOURCE: IQVIA

US Trade Tariffs and Economic Cost Pulse Uncertainty 68 | IRISHPHARMACYNEWS.IE

Top RX Classes by Value

13.5% Wage pressure is particularly important because the community pha service provision model and 18.4% the provision of additional clinical servic 14.5% pharmacists and pharmacy team members. The below table shows re 25% 22.8% costs Pain above 5%. Relief 26.4% Cough, Cold & Respiratory 37% 18.4% VMS & Tonics 14.5% Digestive & Other Intestinal 13.5% Skin Treatment 6.1% Wages 6.2% 6% SOURCE: IQVIA Energy

39.2%

Other 21.1%

71%

76%

7.8%

9% IT infrastructure 11.3% 11% Insurance

12.7% 12%

wages and ITduring infrastructure where respondents report the most Waste charges Global economic uncertainty Energy, remained elevated Q2 remain the areas in Q2 2026

66%

53%

45%

pharmacists and pharmacy team members. The below table shows respondents who reported an increase in costs above 5%.

Cost Pulse

Wages 71% 67% Energy, wages and IT infrastructure remain the areas Energy 76% 79% in Q2 2026 where respondents IT infrastructure 66% 60% report the most substantial cost increases. IT expenditure Insurance 53% 46% is likely to remain significant as pharmacies adapt to greater Waste charges 45% 35% digital integration and changes Rents 37% 35% in healthcare infrastructure as outlined in the digital health Security 37% 34% framework for Ireland. Wage pressure is particularly important Commercial rates 26% 22% because the community Banking 28% 20% pharmacy sector has a labourintensive service provision model and the provision of additional clinical services requires appropriately trained pharmacists and pharmacy team members. The below table shows respondents who reported an increase in costs above 5%

Business Environment Sentiment Pulse

When asked how do pharmacy owners/managers see their business prospects now compared to 12 months ago respondents to the IPU survey indicated they were:

Business Environment Sentiment Pulse

40% 35% 30% 25% 20% 15% 10% 5% 0%

More optimistic

Less optimistic

Same Q1

No opinion

When asked how do pharmacy owners/managers see their business prospects now compared to 12 months ago respondents to the IPU survey indicated they were:who reported an increase in costs above 5%

When asked how pharmacy owners/managers view the business environment at present. 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0%

Improving

Getting worse

No change Q1

No opinion

The level of pharmacy footfall in the last 12 months as reported by respondents. 60% 50% 40% 30% 20% 10% 0%

Increased

Reduced

Same Q1

Don’t know

IRISHPHARMACYNEWS.IE | 69

Completed Deals in Q2 by Geographical Location

DUBLIN

REST OF LEINSTER

MUNSTER

ULSTER / CONNACHT

Leinster Dublin Munster Ulster/Connacht

SOURCE: FITZGERALD POWER

PSI data suggests there have been 4 net openings in the first 6 months of 2026, leaving the number of community pharmacies in Ireland at 1,920.

New Openings and Closures

months of 2026, leaving the number of community pharmacies in Ireland10at 1,920.

€250k and over

PCRS Pulse

€175k-249k

8 4

Closures between

Net between 1st Openings January 2026 – 30th June 2026 1st January 2026 – 30th June 2026 1

Q2 2026 8

0 Net Openings between SOURCE: PSI 1st €100k-174k January 2026 – 30th June 2026 Under €100k

SOURCE: FITZGERALD POWER

New Openings between Openings Closures 1stNew January 2026and – 30th June 2026 Q1 2026 net openings in the first 6 months of Fitzgerald Power estimate 7 transactions completed in the 2nd Completed Deals in Q1 2026 and Q2 2026 by HSE Fees List Position 2026, leaving the number of community Quarter of 2026. In the first two quarters in 2025 there were 17 pharmacies at 1,920. Closures between New Openings between transactions as opposed in to Ireland 15 in 2026. 15 1st1stJanuary 30thJune June2026 2026 January2026 2026 – 30th PSI data suggests there have been 4 net openings in the first 6 PSIPulse data suggests there have been 4 Market

SOURCE: PSI 1 Q1 2026 Q2 2026 Completed Deals in Q1 2026 and Q2 2026 by Pharmacy Type The quantum of fees received by the pharmacy sector for all community drug scheme categories increased over 2025, 20with vaccinations (17%) and DPS/LTI (22%) seeing particularly strong growth. GMS fees have seen growth The quantum fees received by theHigh-Tech pharmacy sector for all community scheme categories increased over of 6% over the year. of Contraception and fees have both seen 8%drug growth. PCRS Pulse

SOURCE: FITZGERALD POWER

PCRS Pulse

15 2025, with vaccinations (17%) and DPS/LTI (22%) seeing particularly strong growth. GMS fees have seen growth The quantum of fees received by the pharmacy sector for all community drug scheme categories increased over 2025, with vaccinations of 6% over(22%) the year. Contraception and High-Tech fees haveseen both seenof8%6% growth. (17%) and DPS/LTI strong growth. GMS growth over the year. Contraception and HighThe 10 table below showsseeing the particularly level of fees received fromfees thehave State by the pharmacy sector in relation to 8 Tech fees have both seen 8% growth. The table below shows the level of fees received from the State by the pharmacy sector in relation to community schemes in 2024 6 community drugdrug schemes in 2024 and 2025. and 2025. 5 The table below shows the level of fees received from the State by the pharmacy sector in relation to

community drug schemes in 2024 and 2025. 0

2024 €

1 0 2025 €

Indigenous Group

2024 € 16,221,170 Independent

GMS, & Opioid Substitution Treatment Scheme Fees GMS, & Opioid Substitution Treatment Scheme

344,199,455

DPS & LTI

88,554,517

Pharmacy Contraception Fee

10,246,433

11,115,498

High-Tech High-Tech

50,253,645 50,253,645

54,164,516 54,164,516

Vaccination Corporate Group Vaccination

Fees

DPS & LTI Pharmacy Contraception Fee

2025 €

16,221,170

18,911,180 Symbol 18,911,180

344,199,455

363,281,005

88,554,517

363,281,005 107,685,046

107,685,046

11,115,498

A part ofA this in 2025 mightmight be due to changes in inthe resultingfrom fromthe the Community part growth of this growth in 2025 be due to changes thefee feestructure structure resulting Community Pharmacy Agreement, place in September2025. 2025. Under Under this this agreement, fees perper item Pharmacy Agreement, whichwhich camecame intointo place in September agreement,the the fees item reimbursed the State increased, as shown in the below table. reimbursed by the by State increased, as shown in the below table. | IRISHPHARMACYNEWS.IE 70

the goal of investment should ultimately be to e

A part of this growth in 2025 might be due to changes in the fee structure resulting from the Community they add greatest value. Digital A part of thisAgreement, growth in 2025 might came be due into to changes fee structure resulting fromthe the Pharmacy Agreement, Pharmacy which placeininthewhere September 2025. Under thisCommunity agreement, the fees per item syste which came into place in September 2025. Under this agreement, the fees per item reimbursed by the State increased, as shown in the reimbursed below table. should improve workflow, reduce administrativ below table. by the State increased, as shown in the

First 1,667 items

patient services. Similarly, investment in people Old Fee New Fee service and, over the longer term, improved pro €5.00

€5.60

This quarter’s findings show a sector with healt €4.50 €4.50 sustained cost Each other item dispensed in that month €3.50pressure. That makes €4.10 regular be ever. Pharmacy owners who understand the ke For comparison, in 2024 aggregate GMS reimbursements byreimbursements 4% and decisions, DPS/LTI reimbursements For comparison, in 2024 aggregate GMS reimbursements increased by 4%increased and investment DPS/LTI increased by protect 10%. The fact margin that informed Each of the next 833 items

increased 10%. The above fact that meaningfully above 2024ingrowth suggests that at fee least a part of 2025 growth by is meaningfully 2024 2025 growthgrowth suggests is that at least a part of the growth 2025 is due to changes in the structure that was brought into place by the new Community Pharmacy Agreement. the growth in 2025 is due to changes in the fee structure that was brought into place by the new Community Ultimately, success in community pharmacy wil Pharmacy Agreement.

but by who operates the most efficient, profita Measuring Productivity, Not Just Turnover technologies.. Leigh Quilty, Pharmacy Partner says, “For many pharmacy owners, turnover is the first metric they look at when assessing business performance. While sales growth is undoubtedly positive, it tells only part of the story. In today’s environment, where wages, energy, technology and other operating costs continue to rise, increasing turnover does not necessarily translate into improved profitability.

Leigh Quilty

“The most successful pharmacies are increasingly focused on productivity rather than simply growth. That means understanding how effectively every euro of revenue is being generated. Measures such as gross margin, payroll as a percentage of turnover, profit per dispensing item, revenue per employee and EBITDA provide a far more meaningful picture of business performance than turnover alone.

Pharmacy Partner

“As pharmacists take on more clinical services and invest in new technology, productivity becomes even more important. At its core, pharmacy is a service-led model built around the delivery of expert care, so the goal of investment should ultimately be to enable pharmacists and their teams to spend more time where they add the greatest value. Digital systems should not simply be viewed as an additional cost; they should improve workflow, reduce administrative demands and create more capacity for higher-value patient services. Similarly, investment in people should support greater efficiency, stronger customer service and, over the longer term, improved profitability.

Take a proactive step to unlock your pha potential and maintain a competitive edg

“This quarter’s findings show a sector with healthy levels of activity, but also one operating under sustained cost pressure. That makes regular benchmarking and financial analysis more important than ever. Pharmacy owners who understand the key drivers of productivity will be better placed to make informed investment decisions, protect margins and build resilient businesses. “Ultimately, success in community pharmacy will not be measured by who has the highest turnover, but by who operates the most efficient, profitable and sustainable business, and who adapts to new technologies.”

Get in touch with Leigh today: lquilty@

Head Office

Waterford

Greyfriars

Saint John’s Parish Hall

50-5

Waterford

Catherine Street

Mer

X91 K2WV

Waterford

Dub

X91 X827

D04

T: (0)51 870152

T: (0

F: (0)51 871214

F: (0

IRISHPHARMACYNEWS.IE | 71

Diabetes Report

Diabetes Strategy Sets Ambitious Vision for Better Care Across Ireland New national review identifies workforce shortages, technology gaps and the need for a more integrated approach to diabetes care Minister for Health, Jennifer Carroll MacNeill TD

substantially higher rates of depression, anxiety and diabetesrelated distress than the general population. Global surveys suggest that four out of five people with diabetes experience periods of burnout, while almost two-thirds report that the fear of developing long-term complications negatively affects their wellbeing. Irish data similarly demonstrate that many patients would welcome greater discussion of mental health as part of routine diabetes care but currently do not receive it. Diabetes care in Ireland is at a pivotal moment. With the number of people living with diabetes continuing to rise and services under increasing pressure, the publication of the Department of Health's Diabetes Policy and Services Review: A Strategy for Better Care represents the most comprehensive examination of diabetes services undertaken in over a decade. More than simply a review of existing provision, the 155-page document sets out an ambitious roadmap for transforming diabetes care over the next five years, with significant implications for hospital pharmacists, consultant endocrinologists and multidisciplinary diabetes teams. The report paints a balanced picture. It acknowledges the considerable progress made in diabetes prevention, treatment and technology over recent years, while also highlighting significant regional variation in services, persistent workforce shortages and inequitable access to specialist care. Central to its message is the recognition that, without substantial investment and service redesign, Ireland will struggle to meet the growing clinical demands associated with one of the country's fastestgrowing chronic diseases.

IRISHPHARMACYNEWS.IE

A Growing Public Health Challenge

professionals across both hospital and community settings.

Diabetes has long been recognised as one of the defining healthcare challenges of the 21st century, but the scale of the issue facing Ireland is particularly striking.

The report describes diabetes as a condition that demands continuous self-management by patients while simultaneously requiring highly coordinated specialist support throughout every stage of life—from childhood and pregnancy through adulthood and into older age.

In the absence of a National Diabetes Registry, the report estimates that more than 308,000 people in Ireland are currently living with diabetes, representing approximately six per cent of the population. Around 90 per cent have Type 2 diabetes, while between 20,000 and 30,000 adults are living with Type 1 diabetes. Ireland also has one of the highest incidences of childhood Type 1 diabetes in Europe, with around 350 children diagnosed each year. Beyond these headline figures lies an even greater challenge. Diabetes is no longer viewed solely as a disease requiring glucose management. Increasingly, patients are living longer with multiple long-term conditions including cardiovascular disease, chronic kidney disease, obesity, liver disease, dementia and mental health disorders. As a result, diabetes management has become considerably more complex, requiring coordinated input from multiple healthcare

The Hidden Burden of Living with Diabetes While discussions around diabetes often focus on clinical outcomes and healthcare costs, the review also shines a light on the daily realities faced by people living with the condition. For many patients, diabetes is a relentless condition requiring constant decision-making around insulin dosing, blood glucose monitoring, nutrition, physical activity, illness management and medication adherence. Every day involves hundreds of decisions that most people never need to consider. The psychological burden is equally significant. Drawing on international evidence, the report notes that people living with diabetes experience

This emphasis on psychological wellbeing is an important theme throughout the review and reflects growing international recognition that successful diabetes management extends well beyond pharmacological treatment alone. Why Hospital Services Remain Central Although much of Ireland's diabetes strategy rightly focuses on prevention and communitybased care, hospital services remain central to the management of complex diabetes. Patients with Type 1 diabetes, complicated Type 2 diabetes, diabetes in pregnancy, severe hypoglycaemia, diabetic ketoacidosis and multiple diabetes-related complications continue to rely heavily on specialist hospital teams. The report highlights the increasingly important role played by multidisciplinary diabetes services within acute hospitals. Consultant endocrinologists, diabetes specialist nurses, advanced nurse practitioners, dietitians, podiatrists, psychologists, pharmacists and administrative teams all contribute to delivering specialist care that extends far beyond traditional outpatient clinics.

73 For hospital pharmacists, this evolution is particularly significant. Pharmacists are increasingly involved in medicines optimisation, initiation of newer therapies, medication safety, patient education and multidisciplinary decision-making. As therapeutic options continue to expand—with newer insulin analogues, GLP-1 receptor agonists, SGLT2 inhibitors and increasingly sophisticated diabetes technologies— the pharmacy profession's contribution to diabetes care has never been greater. The review recognises pharmacists as integral members of the multidisciplinary diabetes team and identifies pharmacy services as an important component of future workforce planning. Prevention Must Remain a Priority Despite advances in treatment, the report is unequivocal that preventing Type 2 diabetes remains one of the greatest opportunities to improve both patient outcomes and healthcare sustainability. The strategy supports continued investment in national obesity initiatives, Healthy Ireland programmes and targeted interventions for people identified with pre-diabetes. It also endorses the expansion of the HSE's Chronic Disease Management Programme and Enhanced Community Care services, which aim to identify patients earlier and intervene before complications develop. Importantly, the report stresses that prevention is not solely about lifestyle advice. Addressing wider social determinants of health—including deprivation, health inequalities and access to services—is recognised as an essential component of reducing future diabetes prevalence. For hospital clinicians, these developments have important implications. Earlier diagnosis and better community management should ultimately reduce emergency admissions and delay the onset of diabetes-related complications. However, achieving this will depend on sufficient investment across the entire healthcare pathway, rather than simply shifting care from hospitals into the community. Addressing the Workforce Challenge If one message emerges consistently throughout the Diabetes Policy and Services Review, it is that the future success of diabetes care will

depend not simply on new medicines or technologies, but on having enough skilled healthcare professionals to deliver them. The review identifies workforce capacity as one of the greatest barriers to improving diabetes services nationally. While significant advances have been made in diabetes treatments and models of care, many services continue to operate with staffing levels that fall well below internationally recommended standards. The report highlights shortages across almost every discipline involved in diabetes care, including consultant endocrinologists, diabetes specialist nurses, dietitians, podiatrists, psychologists and pharmacists. These shortages are contributing to regional variation in service provision, with some patients benefiting from comprehensive multidisciplinary support while others have limited access to specialist services depending on where they live. For hospital pharmacy departments, this presents both a challenge and an opportunity. As medicines become increasingly specialised and diabetes management grows more complex, pharmacists are assuming greater responsibility for medicines optimisation, therapeutic review, patient counselling and supporting multidisciplinary prescribing decisions. However, expanding these clinical roles requires sufficient staffing, protected time for specialist practice and ongoing professional development. The review recognises that strengthening multidisciplinary diabetes teams will require sustained investment over several years rather than isolated recruitment initiatives. The Expanding Role of Hospital Pharmacy Hospital pharmacists have become integral members of diabetes multidisciplinary teams. Historically, pharmacy involvement often centred on dispensing and medicines supply. Today, pharmacists contribute directly to clinical decisionmaking, reviewing treatment regimens, supporting medication adherence, identifying prescribing risks and advising on increasingly sophisticated therapies.

expanded considerably. Newer insulin analogues, GLP-1 receptor agonists and SGLT2 inhibitors have transformed the management of both Type 1 and Type 2 diabetes while also demonstrating cardiovascular and renal benefits that extend beyond glucose control. For pharmacists, keeping pace with this evolving evidence base requires continual education and close collaboration with consultant endocrinologists and specialist nursing teams. The review recognises that medicines optimisation will remain central to improving outcomes while reducing avoidable complications and hospital admissions. Pharmacists are therefore likely to play an increasingly important role in ensuring that patients receive the most appropriate therapies at the right time, while also supporting safe prescribing as treatment pathways continue to evolve. Technology is Transforming Diabetes Care Perhaps no area of diabetes management has advanced more rapidly than diabetes technology. Continuous glucose monitoring (CGM), flash glucose monitoring, insulin pumps and hybrid closedloop systems are fundamentally changing how people with diabetes manage their condition. The review strongly supports expanding equitable access to these technologies based on clinical need rather than geographical location. While Ireland has made considerable progress in recent years, access remains inconsistent, with variations between hospital sites and healthcare regions. The report concludes that greater national consistency is required to ensure patients receive the same opportunities regardless of where they access care. For hospital teams, wider adoption of technology brings significant opportunities.

This role has become even more important with the rapid evolution of diabetes medicines.

Continuous glucose monitoring enables clinicians to assess glycaemic patterns in far greater detail than traditional fingerprick testing, allowing treatment decisions to be based on richer clinical data. Hybrid closedloop insulin delivery systems are reducing episodes of hypoglycaemia while improving overall glycaemic control for many patients with Type 1 diabetes.

Over the past decade, therapeutic options have

However, technology alone is not enough.

Successful implementation depends upon comprehensive patient education, clinical governance, regular review and multidisciplinary support. Hospital pharmacists have an important role in this evolving landscape, helping patients understand medicines alongside technology, supporting safe insulin management and contributing to education around new therapeutic pathways. Digital Healthcare Must Continue to Evolve Alongside advances in diabetes technology, the review highlights the need for stronger digital infrastructure across the wider health service. The absence of a comprehensive National Diabetes Registry remains one of the report's most significant findings. Without robust national data, accurately planning workforce requirements, evaluating outcomes and identifying inequalities in care becomes considerably more difficult. The strategy recommends establishing a comprehensive registry capable of supporting service planning, research, audit and quality improvement initiatives. It also advocates greater integration between hospital information systems, primary care records and community services to allow healthcare professionals to access timely, accurate patient information across the continuum of care. For hospital pharmacists, better digital integration offers significant advantages. Electronic prescribing systems, medicines reconciliation, shared clinical records and integrated decision-support tools all contribute to safer medicines management while reducing duplication and improving communication between healthcare providers. As hospitals continue implementing digital transformation programmes, pharmacy teams will remain central to ensuring these systems support both clinical safety and operational efficiency. Addressing Regional Inequalities One of the strongest messages throughout the review is the need to reduce unwarranted variation in diabetes services. Currently, patients' access to specialist clinics, structured education programmes, insulin pump services, podiatry and

IRISHPHARMACYNEWS.IE

Diabetes Report

Chapter 6: Service Gap Analysis and Future Planning

communication with primary care colleagues all have the potential to improve treatment continuity while reducing medication errors and unnecessary readmissions.

Recognising the Importance of Mental Health While advances in medicines and technology dominate many discussions around diabetes, the review places equal emphasis on psychological wellbeing.

Pump Services Pump starts

HSE West and North West

HSE Dublin and North East

Living with diabetes requires continuous self-management, often involving multiple daily decisions around insulin administration, blood glucose monitoring, diet, exercise and illness management. This constant vigilance can have a profound emotional impact.

Pump service coming online Pump maintenance service HSE Dublin and Midlands

No pump service

The review notes that diabetesrelated distress, anxiety and depression remain significantly under-recognised despite strong evidence demonstrating their effect on treatment adherence and long-term clinical outcomes.

HSE Mid West

*Best estimate based on survey responses

HSE Dublin and South East

HSE South West

Figure 6.4.1 Pump Services In Ireland Paediatric pump services are outlined below:

Hospital, Cavan & Monaghan Hospital whose

psychology support can vary Consultant endocrinologists, Integrated Care:pump Breaking Down service is provided via Our Lady of Lourdes considerably depending on where HCLTraditional diabetes specialist nurses, • Insulin pump therapy (including systems) Boundaries Hospital Drogheda pharmacists and both Kerry University they live. and allied health is initiated in 15 of 17 paediatric services One of the central themes running Hospital and Tipperary University Hospital whose professionals will increasingly The report argues that this throughout the Diabetes Policy work alongside GPs, practice pump service is provided by Cork University • There are 1893should children and adolescents on inconsistency no longer and Services Review is the need and community be acceptable. Hospital. There are nurses a number of adult services insulin pumps (52%), but it ranges from 18- away from to move fragmented pharmacists to ensure patients models of care towards a truly accept referrals from paediatric National standards, consistent who cannot 75% in different centres/cohorts receive the right care, in the right integrated diabetes service. workforce planning and equitable place, the to right time.of services on their own siteatdue a lack models are required to three models of • 10funding of 15 services (66%) offer The report acknowledges that resourcing to provide adulthighlights pump service. ensure all patients have access Thean review the insulin pumps (including closed loopwhile systems); specialist hospital services to high-quality diabetes services continued expansion of Enhanced remain essential The for patients 3 of 15 services (20%) offer two pump models; regardless of geography. geographical inequity must beservices addressed Community Care and the with complex diabetes, many 2 of 15 services offer only one pump model. HSE's Integrated Care Programme to ensure adequate transition of care for the For hospital pharmacists working aspects of diabetes management for Chronic Disease as important within regional diabetes networks, paediatric can and should be delivered population transitioning to adult foundations for this approach. Therethis is presents a geographical inequity faced closer by some an opportunity to home. Achieving this, technology across the country. services with By strengthening services to contribute not only to direct of the Irish paediatric population livinghowever, with depends on far stronger patient care but also to service outside the hospital setting, it is collaboration between diabetes, whoprotocol are accessing pump therapy With acute other diabeteshoped technologies, all people redesign, development that more patients canwith be hospitals, primary care, community and quality initiatives service in almost everyimprovement paediatric diabetes diagnosed earlier, receive timely a clinical diagnosis of Type 1 diabetes are eligible services and patients themselves. that promote greater consistency avoid preventable nationwide, but with lesssystem. access to adult pump to access CGM freeintervention of charge.and Consideration across the healthcare complications that ultimately Rather than viewing hospital and

services to continue their pump therapy. Insulin could given to widening accessadmission. based on require hospital community services as be separate Ultimately, the review makes clear pumpthat therapy is initiated the majority of systems, the review advocates clinical need,afor example those who require improving diabetes in outcomes For hospital pharmacists, will require far more than individual single,being coordinated model of care monitoring. paediatric diabetes services, the exceptions frequent glucose integrated care creates new service improvements. It calls for which patients move seamlessly Letterkenny University Hospital whoseinpump opportunities to support coordinated national leadership, between different levels of support medicines optimisation beyond service is provided through Sligo University sustained workforce investment according to their clinical needs. and stronger collaboration across every discipline involved in diabetes care.

For hospital teams, this represents an important cultural shift.

Diabetes Policy and Services Review | A Strategy for Better Care

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Patients frequently report feeling overwhelmed by the daily demands of managing their condition, while fear of hypoglycaemia, complications and future health problems can contribute to ongoing psychological stress. These issues affect people of all ages, from children newly diagnosed with Type 1 diabetes through to older adults managing multiple longterm conditions. To address this, the strategy recommends greater integration of psychology services within diabetes multidisciplinary teams and encourages routine assessment of emotional wellbeing as part of clinical care.

For hospital pharmacists, this reinforces an increasingly holistic approach to medicines optimisation. Supporting patients extends beyond explaining how medicines work. Every interaction provides an opportunity to identify concerns about treatment, discuss adherence challenges and recognise when wider psychological support may be required.

Investing Today to Reduce Tomorrow's Costs

the hospital walls. Medicines reconciliation, discharge planning, patient education and closer

Perhaps one of the report's strongest messages is that improving diabetes services should be viewed not simply as a healthcare cost but as a longterm investment.

75 Diabetes is associated with substantial expenditure across the health service, much of which relates not to routine diabetes management but to treating preventable complications. Cardiovascular disease, kidney failure, stroke, diabetic foot disease, vision loss and hospital admissions account for a significant proportion of diabetesrelated healthcare costs. The review argues that investment in prevention, earlier diagnosis, multidisciplinary care and modern treatment pathways has the potential to reduce these complications while improving quality of life for patients. From a hospital perspective, the implications are significant. Reducing avoidable admissions and preventing complications would not only improve patient outcomes but also release valuable capacity across already stretched acute services. The report therefore presents diabetes investment as both a clinical necessity and a financially responsible approach to long-term healthcare planning. Research, Innovation and Continuous Improvement Another important theme is the need to embed research and quality improvement more firmly within diabetes services. Ireland has contributed significantly to international diabetes research in areas including clinical trials, technology evaluation and epidemiology. The review argues that these strengths should continue to be developed through greater collaboration between hospitals, universities and research organisations. For hospital pharmacy departments, this presents exciting opportunities. Pharmacists are increasingly involved in medicines evaluation, audit, prescribing optimisation,

pharmacoeconomic assessment and service development. As new diabetes therapies continue to emerge, pharmacy-led research will play an important role in evaluating clinical effectiveness, patient outcomes and value for the health service. The strategy also encourages ongoing audit and service evaluation to ensure that new models of care deliver measurable improvements for patients. What Success Will Look Like The Diabetes Policy and Services Review is ambitious in both scope and vision. Its recommendations extend beyond individual clinical disciplines, recognising that improving diabetes care requires coordinated action across workforce planning, digital infrastructure, education, prevention, research and service delivery. For hospital pharmacy, the report reflects the profession's growing contribution to modern diabetes management. Medicines continue to evolve rapidly, technology is transforming patient care and pharmacists are increasingly recognised as key members of multidisciplinary diabetes teams. From supporting complex prescribing decisions to improving medicines safety and patient education, pharmacy's contribution will only continue to grow. However, the report also makes clear that these ambitions cannot be achieved without investment. Expanding multidisciplinary teams, improving access to diabetes technology, strengthening digital systems and reducing regional inequalities will require sustained commitment over many years. The publication of the review therefore represents not the conclusion of a policy process, but the beginning of a significant programme of healthcare reform.

Looking Ahead For healthcare professionals working in diabetes services, the review provides a clear direction of travel. It recognises the outstanding work already taking place across Ireland while acknowledging that demand continues to outpace capacity in many areas. The challenge now lies in translating policy into practice. For hospital pharmacists, this will mean continuing to expand their role in medicines optimisation, multidisciplinary working, patient education and service innovation while helping to shape increasingly integrated models of care. As diabetes prevalence continues to rise and treatment options become more sophisticated, collaboration between every member of the multidisciplinary team will become even more important. Ultimately, the review offers an optimistic vision. It envisages an Ireland where diabetes services are equitable, integrated, digitally enabled and centred around the needs of patients rather than organisational boundaries. For hospital pharmacy, it also represents recognition that the profession has become an indispensable part of delivering safe, effective and patient-centred diabetes care. The task now is to ensure that the workforce, infrastructure and investment are in place to turn that vision into reality. Minister for Health, Jennifer Carroll MacNeill, said, “There have been substantial advances in the delivery of diabetes care in recent years, including the introduction of the National Framework for the Integrated Prevention and Management of Chronic Disease. This has supported the rollout of the Chronic Disease Management Programme and the establishment of community-based specialist

teams for people living with type 2 diabetes. This strategy aims to ensure that people living with all types of diabetes, regardless of their location, have equitable access to a consistently high standard of care.” The Government has committed to developing a new strategy for diabetes care in its Programme for Government, ‘Securing Ireland’s Future.’ The strategy marks a major milestone in diabetes care in Ireland, representing the development of a unified approach to the delivery of diabetes care. HSE Chief Clinical Officer, Dr Colm Henry, added, “I welcome the completion of this report and look forward to working with colleagues to ensure its effective implementation. Diabetes represents a major challenge for those living with the condition and ensuring effective and consistent care across the country will make a significant difference in their lives. “It will also help to ensure that care is delivered at the most effective level possible, thereby also ensuring the most effective use of the resources of the health system.” Diabetes Ireland, Professor Hilary Hoey, Chairperson, highlighted, “I am delighted to welcome the publication of this strategy for diabetes care. Diabetes Ireland was happy to have collaborated with the Department of Health and the HSE to develop the strategy; implementation of its recommendations will make a difference in the lives of people living with diabetes in this country. I look forward to working with the Department of Health and the HSE to ensure its effective implementation.” The HSE will soon finalise an Implementation Framework to complement The Diabetes Policy and Services Review: A Strategy for Better Care and ensure consistent rollout of improvement in diabetes care across the regions.

Summer Shorts Webinars As the pace of change across healthcare and pharmaceuticals continues to accelerate, staying informed doesn’t stop for the summer months! To help keep you informed, The Pharmaceutical Managers’ Institute launched the PMI Summer Shorts – a series of five concise, high-impact webinars designed specifically for busy pharma professionals. Running throughout June, July and August, each 40-minute session brings together senior industry leaders, healthcare stakeholders and subject matter experts to share practical insights, perspectives and experiences on some of the most topical issues facing the industry today. Attendance at this series is completely free for PMI members. Visit www.thepmi.com for full details of all the webinars.

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Heart Health

Overview of Semaglutide and Cardiovascular Outcomes Cardiovascular (CV) disease is one of the leading causes of mortality globally with a prevalence of 19.8 million deaths in 2022, which represents 32% of deaths worldwide (WHO, 2025). CV disease is primarily driven by obesity and diabetes, through vascular stiffness, atherosclerosis and inflammation. Brown et al. (2023) found that within a cohort of 450,000, the incidence of cardiovascular events rose progressively amongst increased BMI categories, and that normal weight diabetes presents a similar risk to those with non-diabetic obesity. Additionally, this study indicated that measures of obesity and diabetes are only weakly linked with CV biomarkers, suggesting that other factors contribute to the increased risk of CV disease. This highlights the need for treatments that target the underlying disease mechanisms rather than focusing solely on metabolic risk factors. Written by Karina Vencaite Karina works as a Cardiac Physiologist in Our Lady of Lourdes Hospital, Drogheda. She has a BSc in Health Physiology and recently graduated from the MSc in Clinical Measurement Physiology in Atlantic Technological University.

One such therapeutic approach is semaglutide, or otherwise known as Ozempic, a glucagon-like peptide-1 receptor agonist (GLP-1 RA), initially developed for the treatment of type 2 diabetes and now approved for weight control. GLP-1 is a hormone primarily produced by endocrine cells within the gut and brainstem neurons in response to food consumption, and plays a role in regulating glucose metabolism (Cherney et al., 2021). GLP-1 enhances insulin release in a glucose-dependent manner, inhibits glucagon secretion, delays gastric emptying and decreases appetite. These effects are mediated through the activation of the GLP-1 receptor that is found across various tissues (Cherney et al., 2021). GLP-1 RAs, such as semaglutide, replicate the

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action of the natural hormone and therefore are used in the treatment of diabetes and obesity. Through comparisons of various GLP-1 RAs, evidence has shown that semaglutide provides a reduction in MACE and CV mortality, suggesting that it may act as a cardioprotective agent (Wei et al., 2021). A systemic review and meta-analysis of randomised controlled trials further reported that, with regard to safety of semaglutide, it reduces the likelihood of CV adverse events without increasing the occurrence of acute kidney injury, pancreatitis or cancer (Sadraei et al., 2025). Additionally, they found that semaglutide aids in the improvement of several cardiometabolic risk factors

such as reductions in BP, lipid levels and inflammatory markers, which may partly explain the reduction in MACE. Similarly, a recent meta-analysis reported significant reduction in CV outcomes, including an 18% reduction in MACE in patients receiving semaglutide, alongside improvements in cardiometabolic parameters (Yao et al., 2025). These findings suggest that the CV benefits of semaglutide may extend beyond glycaemic control and could encompass multiple physiological mechanisms. Evidence from Cardiovascular Outcome Trials Over the past decade, several large-scale clinical trials have investigated the drugs effects on CV outcomes in patients with and without diabetes and those with obesity. As with many of the CV outcome trials, these studies primarily assessed MACE, including CV death, non-fatal MI, and non-fatal stroke. The key major trials investigating these outcomes include SUSTAIN-6 (2016), PIONEER 6 (2019), SELECT (2023), STEP-HFpEF (2023), STEP-HFpEF DM (2024), SELECT HbA1c subgroup analysis (2024) and SOUL (2025).

The SUSTAIN-6 trial was one of the first CV outcome trials to evaluate semaglutide in patients with type 2 diabetes. Marso et al. (2016) assigned 3297 patients into semaglutide and placebo groups and found that 108 of 1648 patients in the semaglutide group experienced a MACE, in comparison to 146 of 1649 of the placebo group. Similarly, the PIONEER-6 trial assessed the CV safety of oral semaglutide in 3183 patients, using similar patient populations. Husain et al. (2019) findings also reported a reduction in CV death and overall CV events, demonstrating oral semaglutide to be non-inferior to placebo when both were used alongside standard treatment. The SOUL (2025) trial expanded on the earlier findings from PIONEER 6 by investigating oral semaglutide in a similar patient population, testing the CV efficacy rather than the safety of the drug, in which they demonstrated a significant reduction in MACE (McGuire et al., 2025). More recently, the SELECT trial investigated the CV effects of semaglutide in those with obesity without diabetes. In this study, 17,604 patients were randomised to receive semaglutide or placebo, with a result of 6.5% experiencing a MACE in the semaglutide group and 8.0% in the placebo. Additionally, a mean body weight reduction of 15.2% in overweight patients (Lincoff et al., 2023). This trial also suggested that the CV benefits of semaglutide extend further than glycaemic control and can also be as a result of weight reduction and beneficial changes in cardiometabolic risk factors, as well as a decrease in visceral adipose tissue. In this trial, semaglutide produced a 37.8% reduction in high-sensitivity C-reactive protein levels, comparable to reduction previously reported with statin therapy, indicating that antiinflammatory mechanisms may contribute to semaglutides CV benefits (Asher and Houston, 2007).

Golden Eye 0.1% w/v eye drops solution Propamidine isethionate AVAILABLE FROM YOUR PREFERRED WHOLESALER

Anti-infective eye drop for superficial eye infections.1 Dosing: 1 to 2 drops up to four times daily.1 Clear, colourless solution in a convenient 10 ml dropper bottle.1 Pregnancy and Lactation: Safety of use in pregnancy and lactation has not been established. Use during pregnancy and lactation only if considered essential by a physician. OTC

Product Name

Pack Size

UD Code

Allphar Code

EAN Code

License Number

Golden Eye 0.1% w/v eye drops solution Propamidine isethionate

10 ml

919895

801725

5391535850013

PA22695/001/001

References: 1. SmPC Golden Eye 0.1% w/v Eye drops, solution-25th July 2024

Additional information available on request.

For further information on this product, please contact your Athlone Pharmaceuticals Key Account Manager, Richard Doherty: +353 (0)87 483 6873 or our customer service team. Athlone Pharmaceuticals Ltd., Connaught House, 1 Burlington Road, Dublin 4, Ireland. Email: enquiriesap@kent-athlone.com

Date of preparation: July 2026 Ref: IE2026/021/00

Product Authorisation Holder: Cambridge Healthcare Ireland Limited 20 Holles Street, Dublin 2, Ireland.

Heart Health

On the other hand, the STEPHFpEF and STEP-HFpEF DM trials evaluated the effects of semaglutide in patients with obesity related heart failure with preserved ejection fraction, in comparison to the previous studies that focused on MACE. These trials assessed changes in the 6-minute walk test distance, therefore investigating symptom burden and functional improvement. In a non-diabetic cohort, Kosiborod et al. (2023) found that patients in the semaglutide group experienced improvements in symptoms, exercise capacity and higher weight loss, in comparison to the placebo group, as well as reduced NT-proBNP levels. In diabetic patients, Kosiborod et al. (2024) found matching results with improvements in CRP levels, 6-minute walk test distance and in quality of life. Interestingly, improvements in HF outcomes were observed despite patients with diabetes experiencing 40% less weight loss than non-diabetics. This suggests that cardioprotective effects of semaglutide may extend beyond weight loss and could also be driven by additional mechanisms such as inflammation, vascular function and cardiac metabolism (Kosiborod et al., 2024).

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Notably, all of the trials reported a higher proportion of patients discontinuing treatment in the semaglutide groups compared to placebo due to adverse events, those mainly being gastrointestinal symptoms, including nausea, vomiting and diarrhoea. Despite this, the overall CV benefits observed suggest that these adverse effects do not outweigh the therapeutic advantages of semaglutide. Insulin Resistance Whilst GLP-1 RAs are commonly used in the treatment of type 2 diabetes and obesity, their therapeutic effects are closely linked to improvements in insulin resistance, a key underlying mechanism in both conditions, suggesting that targeting insulin resistance may be a key mechanism for the drug’s CV benefits. Insulin resistance contributes to CV disease through increased circulating free fatty acids and dyslipidaemia, reduced nitric oxide leading to endothelial dysfunction, activating inflammatory pathways and increasing sympathetic nervous system activity, collectively increasing risk of atherosclerosis and MACE (Kosmas et al., 2023). Bistola et al. (2018) indicated that insulin resistance has been associated with an increased

risk of CV disease even in those without diabetes, reinforcing its role in cardiometabolic disease. GLP-1 RAs improve insulin sensitivity through activating GLP-1 receptors on pancreatic β- cells and triggering enhanced insulin secretion and glucose uptake and so reducing hepatic glucose production and improving metabolic control (Papakonstantinou et al., 2024). This may contribute to the cardioprotective effects, including enhanced vascular function and reductions in inflammation and oxidative stress. Weight loss Semaglutide has consistently demonstrated considerable weight reduction amongst both diabetic and non-diabetic populations. Evidence suggests that weight reduction may play a substantial role in explaining the observed reduction in MACE and CV mortality. Obesity can contribute to CV disease through several mechanisms, including the accumulation of adipose tissue surrounding the heart. Epicardial adipose tissue has been shown to affect cardiac structure and function, as well impair LV relaxation leading to diastolic dysfunction, particularly in HF

patients (Pugliese et al., 2025). Additionally, obesity can promote inflammation and metabolic effects, leading to insulin resistance and eventually diabetes (Park et al., 2014). Semaglutide reduces excess adipose tissue through appetite suppression, as well as improving insulin sensitivity and metabolic regulation which may enhance lipolysis and so reduce adipose accumulation (Crispino et al., 2025). GLP-1 RAs can suppress appetite by activating the GLP-1 receptors within the hypothalamus, stimulating satiety-inducing neurons and inhibiting the appetite stimulating pathways (Papakonstantinou et al., 2024). This reduction in overall body weight can lead to reductions in cardiac workload, as obesity increases blood volume, elevated cardiac output and thus greater myocardial oxygen demand (Ashfield and Ojha, 2025). Although semaglutide has been shown to contribute to marked weight loss and beneficial changes in cardiometabolic risk factors, it is important to consider their long-term maintenance. Wilding et al. (2022) investigated changes in weight and cardiometabolic risk factors following semaglutide therapy. They found that, after a year, patients were able to

maintain improvements in some cardiometabolic risk factors such as cholesterol, triglycerides and CRP. These improvements occurred despite regaining weight lost during the trial, but do were less than improvements achieved during treatment, as factors such as mean systolic BP and diastolic BP reverted back to baseline levels. Additionally, they found that after a year of withdrawal from semaglutide treatment, patients regained most of their weight loss achieved during the trial. Approximately 11.6% of weight was regained among participants, reducing the overall weight loss in the trial from 17.3% to an overall loss of 5.6%. These findings suggest that although some cardiometabolic benefits may remain following treatment withdrawal, the substantial weight gain observed highlights the importance of continued therapy to sustain the full CV benefits of semaglutide. However, although weight reduction likely plays a prominent role in the CV benefits of semaglutide, it may not fully explain the observed improvements in CV outcomes. Blood pressure and Vascular effects Elevated blood pressure increases the risk of CV disease

by increasing the workload on the heart and damaging blood vessels over time, which can lead to HF. HTN increases myocardial workload by raising the resistance against which the heart must pump, leading to compensatory structural changes (Shams et al., 2025). Although GLP-1 RAs consistently reduce systolic BP by approximately 2–6 mmHg, Marx et al. (2022) argue that this reduction alone is unlikely to fully explain their cardiovascular benefits. Proposed mechanisms include natriuretic and diuretic effects, leading to increased sodium excretion, improved renal haemodynamics and reduced angiotensin II levels, which may also attenuate vascular inflammation and oxidative stress (Yu et al., 2022). Studies suggest that GLP-1 RAs may improve oxidative stress by reducing reactive oxygen species production and enhancing antioxidant defence pathways, including increased antioxidant enzymes that protect against oxidative damage (Yaribeygi et al., 2021).

activation has shown to reduce BP after several weeks of treatment, particularly in those with HTN and with effects occurring independent of weight reduction.

Cherney et al. (2021) indicate that acute semaglutide administration may lead to transient increases in BP through sympathetic nervous system activation. Whereas sustained GLP-1 receptor

Although improvements in BP and other haemodynamic parameters may contribute to CV benefits, they may not fully account for the overall benefits observed with semaglutide. Beyond these,

The SELECT trial demonstrated that semaglutide reduced mean systolic BP by 3.3mmHg across all BP categories (Lincoff et al. 2023). Kennedy et al. (2024) reported that each kilogram of weight loss is typically associated with an approximately 1 mmHg reduction in systolic BP, therefore, the weight loss achieved in the STEP trials would be expected to reduce systolic BP by around 13 mmHg, compared with the observed reduction of approximately 5 mmHg. Furthermore, Ala and Moheb Aleaba (2024) found that BP improvements were evident before significant weight loss occurred, suggesting further that mechanisms beyond weight reduction may contribute to BP regulation and CV benefits. Effects on cardiac structure and function

semaglutide may exert direct effects on cardiac structure and function. Pugliese et al. (2025) describe a correlation between excess weight, epicardial adipose tissue and LV remodelling, with changes in LV mass correlating with LV and LA volumes, contributing to diastolic dysfunction. Although these findings were reported with tirzepatide, a GIP/GLP-1 RA, they provide insight into the effects of incretin-based therapies more broadly, thus suggesting that more needs to be established with regards to semaglutide applicability. Solomon et al. (2024) conducted an echocardiographic sub study of the STEP-HFpEF Trial in order to observe effects of semaglutide on cardiac structure and function. The results demonstrated that semaglutide improved several markers of cardiac remodelling including reduction in LA volume, improvement in LV diastolic function, and changes in RV size. These effects were seen across all subgroups. Additionally, they found semaglutide to attenuate the progression of HFpEF associated remodelling, indicating that it does not just improve symptoms but also can be used as a treatment to target underlying pathophysiological mechanisms, such as adiposity and haemodynamic load.

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Heart Health

Structural changes such as LA enlargement are established risk factors for atrial fibrillation (AF) (Nattel and Harada, 2014). A meta-analysis by Saglietto et al. (2024) reported a 42% reduction in AF, independent of BMI, weight loss and route of administration. In addition to weight loss, they link semaglutide to the reduction in local inflammation and oxidative stress, as well as improvements in insulin resistance which may contribute to reduced atrial workload and thus atrial remodelling (Ciconte et al., 2026). Consequently, reductions in atrial fibrillation incidence with semaglutide may decrease risk of thromboembolic events, such as stroke, therefore contributing to overall reductions in MACE.

and thus decreased cardiac afterload (Bonfioli et al., 2024). A 12-week study by Navodnik et al. (2023) demonstrated improved endothelial function, with brachial artery flow-mediated dilation increasing from 5.81% to 11.1% in the semaglutide group.

Anti- inflammatory effects

Much of the emerging evidence surrounding semaglutide has been centred around HF and has been derived from studies conducted with HF patients, particularly those with obesity related HFpEF. Many of these studies have found that semaglutide improves symptom burden, exercise capacity and quality of life, as previously seen in the STEP-HFpEF trials. A recent meta-analysis, by Behers et al. (2026), found no major change in CV mortality or HF exacerbation but did suggest improved quality of life (KCCQ-CSS score)and 6-minute walk duration. While several GLP1 RAs have been studied, the most consistent improvements in exercise capacity have been seen in trials of semaglutide, particularly in patients with obesity related

Semaglutide has been shown to reduce systematic inflammation through circulating inflammatory markers, contributing to its CV benefits. Inflammation promotes endothelial dysfunction, leukocyte adhesion, and atherosclerotic plaque development, which can destabilise and lead to thrombotic CV events (Henein et al., 2022). GLP-1 RAs reduce inflammation through multiple pathways, including the inhibition of proinflammatory cascades, such as NF-kB signalling (Bonfioli et al., 2024). Additionally, GLP-1 RAs enhance endothelial nitric oxide production, leading to improved vascular function, reduced systemic vascular resistance

However, much of the research supporting these antiinflammatory effects involve indirect assessments such as circulating biomarkers, rather than direct measures of vascular or myocardial inflammation, as well as animal studies. Therefore, further research may be needed to clarify the extent to which these anti-inflammatory effects apply to CV improvements. Role in heart failure

HF (Shchendrygina et al., 2024). They point out that as GLP-1 RAs increase heart rate, due to activating GLP-1 receptors in the sinoatrial node, it may be used for HF patients where chronotropic incompetence is prevalent, as well as alongside exercise training in order to improve quality of life and reduce risk of sarcopenia (Neumann et al., 2024). These findings suggest that semaglutide can be used as not only a pharmacological treatment but also as a broader method of managing and improving HF effects. With regards to quality of life, Shchendrygina et al. (2024) further state that lower QoL scores are received from patients with increased BMI or type-2 diabetes, therefore, as GLP-1 RAs therapy can aid in controlling diabetes and obesity, it may help in increasing health-related quality of life, as seen through the STEP HFpEF trials. In contrast, it is evident that semaglutide does not exert the same benefits in patient with HFrEF, as the underlying pathologies are strongly linked to myocardial injury and structure damage, in comparison to HFpEF, which is linked to obesity and inflammation, mechanisms which are targeted by GLP-1 RAs (Pugliese et al. 2025). Although there is limited evidence for the effects of semaglutide in HFrEF, this phenotype is generally associated with lower levels of adiposity, meaning weight reduction strategies may be less applicable and therefore

semaglutide may offer fewer benefits in this patient population (Pugliese et al., 2021). The STEP HFpEF trials have also shown that despite there being an inverse relationship between BMI and NT-proBNP levels, a cardiac biomarker linked to heart failure, and that weight loss may increase NT-proBNP, semaglutide has been associated with a greater reduction in NT-proBNP compared to placebo (Kosiborod et al., 2023; Petrie et al., 2024). This was seen alongside fewer HF events, suggesting that the reduction in NT-proBNP may exert benefits that go beyond weight loss. Limitations of current evidence Although there is substantial evidence surrounding the CV benefits of semaglutide and its ability to reduce MACE, many of the studies focus on outcomes such as weight and symptoms, and a limited amount assess direct cardiac structure and function. The trials completed have relatively short follow-up periods and so limiting the understanding of the long-term effects of semaglutide on the CV system. Additionally, major trials, such as the SELECT trial, primarily include patients with preexisting CV disease, which may reduce generalisability of the findings to lower-risk patients. It is also important to note that although multiple mechanisms have been discussed, the extent to which these CV benefits are independent of weight loss is still questionable. References available on request

News

New Findings in Inflammatory Responses Researchers from Trinity and St. James’s Hospital have shown that dexamethasone, a commonly prescribed anti-inflammatory steroid, can reduce harmful inflammation triggered by Mycobacterium avium without weakening the ability of human immune cells to control the infection. The findings suggest dexamethasone may thus offer a new adjuvant approach for better managing nontuberculous mycobacterial (NTM) disease. The ASSUME program NTM infections present a growing global health challenge, particularly among people with chronic lung disease. Treatment often requires prolonged courses of multiple antibiotics, yet many patients continue to experience symptoms driven by persistent inflammation. Steroids are not routinely used in NTM disease because clinicians have traditionally been cautious about suppressing T cell immune responses during infection.

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“Our study suggests that it may be possible to fine-tune this response by reducing damaging inflammation while still preserving the immune defences that help control infection,” said Dr Donal Cox, senior author of the research, which has just been published in the Journal of Infectious Diseases. Dr Cox and the research team, based in the Trinity Translational Medicine Institute, investigated how human macrophages, specialised immune cells that

act as a first line of defence against infection, respond to Mycobacterium avium. They found that treatment with dexamethasone significantly reduced infection-driven macrophage metabolic activity while also lowering the production of inflammatory signals. Importantly, the steroid reduced the inflammatory response but did not increase bacterial growth within these key immune cells.

Key Findings • Production of “inflammatory cytokines”, TNF, IL-1β, IL-6 and IL-8, which increase inflammation, is markedly reduced following dexamethasone treatment. • Macrophages treated with dexamethasone retain their ability to control Mycobacterium avium. • The findings demonstrate that inflammatory responses can be separated from bacterial control in human macrophages.

News

PGEU Calls for Community Pharmacy to be Embedded in Europe’s Health Crisis Planning Community pharmacists must be formally integrated into Europe’s emergency preparedness and crisis response structures if health systems are to make full use of one of their most accessible healthcare resources, the Pharmaceutical Group of the European Union (PGEU) has said. The organisation launched its new Position Paper on Health Preparedness at its Annual Conference in Wrocław, held under the theme “Ensuring Europe’s health preparedness”. The paper sets out a series of recommendations aimed at strengthening the contribution community pharmacies can make to preventing, preparing for and responding to future health emergencies. Representing a network of more than 200,000 community pharmacies across 33 European countries, PGEU argues that recent crises have demonstrated both vulnerabilities within European healthcare systems and the resilience of community pharmacy. These challenges now extend considerably beyond the threat of another pandemic. Medicine shortages, epidemics, cyber incidents, energy and power disruption, natural disasters and population displacement caused by war all have the potential to interrupt access to healthcare and essential medicines. Throughout recent emergencies, however, community pharmacies have frequently remained operational and accessible to patients. PGEU President Mikołaj Konstanty said the experience of recent years had demonstrated that community pharmacy should be considered an integral component of health preparedness. “Europe’s community pharmacists are a critical part of health preparedness. They are accessible, trusted and present in every community, also when health systems are under pressure,” he said. He added that recent crises had shown pharmacists could maintain continuity of care, support public health interventions, communicate reliable information and reduce pressure elsewhere within healthcare systems. However, he warned: “This potential can only be fully used if pharmacies are formally integrated into emergency planning, properly resourced, and empowered.”

Lessons from across Europe PGEU’s position is supported by practical examples of how community pharmacies have responded to major emergencies across Europe. During the devastating Valencia floods in Spain in 2024, around 200 pharmacies were affected and 92 were inoperative for several days. Despite the disruption, continuity of pharmaceutical care was maintained. More than 600 volunteer pharmacists were mobilised, pharmaceutical care points and emergency medicine kits were established and home care was provided to vulnerable patients. Spain’s pharmacies were tested again during the major power outage of April 2025. Although the disruption affected dispensing operations, the vast majority of pharmacies remained open. Contingency arrangements helped electronic prescription systems continue operating, with more than half a million dispensings completed between 12.30pm and midnight on the day of the outage. Different models have emerged elsewhere. Seven priorities for preparedness PGEU is calling first for the formal inclusion of community pharmacists in emergency and crisis-response strategies, ensuring pharmacy representatives are involved in governance structures, preparedness plans and decision-making processes rather than being brought into responses only after an emergency has occurred. The organisation also wants a proportionate and coordinated European approach to contingency stocks of essential medicines and medical devices. Stockpiling should be rational and productspecific, avoiding duplication and waste or inadvertently placing additional pressure on medicine supply chains. This is reflected in experience from the Netherlands, where regional planning focuses on rapidly determining what medicines are required, what supplies are available and how they can be

delivered, rather than relying disproportionately on large pharmacy-level emergency stocks. PGEU is also advocating an expanded scope of practice for pharmacists during emergencies, allowing them to contribute more extensively to vaccination, testing, shortage management, continuity of treatment and provision of medical countermeasures when other parts of the healthcare system are under exceptional pressure. Better use of aggregated pharmacy data represents another priority. PGEU believes pharmacy data could contribute to preparedness planning, collaborative procurement and shortage management, provided this does not create unnecessary administrative burdens and appropriate data protection and confidentiality safeguards remain in place. Trusted source during a crisis

professionals to communicate evidence-based information and help patients interpret publichealth recommendations. Finally, the organisation is calling for stronger interprofessional preparedness, with structured collaboration between community pharmacists, hospital pharmacists, doctors, nurses, public-health authorities and emergency services established before a crisis occurs. The PGEU Annual Conference brought together national and European policymakers, healthcare professionals and public-health representatives, with participants including the European Commission, DG HERA, DG ECHO, the European Parliament, Vaccines Europe, the Standing Committee of European Doctors and national pharmacy organisations.

Another important element of the recommendations concerns communication.

The message emerging from the conference is that preparedness cannot begin when the next emergency arrives.

Health emergencies can create an environment in which misinformation spreads rapidly, potentially undermining publichealth measures. PGEU believes community pharmacists should therefore be formally incorporated into public risk-communication strategies, using their position as trusted and accessible healthcare

Community pharmacies, it concludes, are ready to contribute to a stronger, coordinated and patient-centred response to future crises. Doing so effectively, however, will require formal recognition of their role, sustainable resourcing and practical empowerment before – rather than during – the next emergency.

IRISHPHARMACYNEWS.IE

Alzheimers Disease

Alzheimer’s Disease: An up-to-date review and focus on new therapies Written by Dr Kevin McCarroll, Consultant Geriatrician, Regional Specialist Memory Clinic at St James’s Hospital, Dublin and Dr Donal Fitzpatrick, Consultant Geriatrician at St James’s Hospital Dublin. causes are rare (1%) but account for up to 5% of cases below 65. These result from mutations in genes that regulate amyloid, including Presenilin 1 & 2 and the Amyloid Precursor Protein (APP) and have an autosomal dominant pattern of inheritance. If symptom onset is below 60 or there is a strong family history, genetic testing should be considered. Symptoms

Dr Kevin McCarroll

Dr Donal Fitzpatrick

Approximately, 65,000 people in Ireland have dementia though the exact number is unknown. The majority of cases (70%) are due to Alzheimer’s disease (AD) with over 90% occurring after the age of 65. While the age at which Alzheimer’s dementia develops has increased, the absolute number of cases has risen due to an ageing population, with prevalence in Ireland expected to more than double over the next 20 years. Dementia incurs significant costs of ¤2 billion annually in Ireland with 90% accounted for by social care.

14 modifiable factors that may account for 45% of dementia cases (including AD) in the general population. The relative contribution of risk factors in the population are: hearing loss (7%), high LDL cholesterol (7%), lower level of education (5%), social isolation (5%) depression (3%), traumatic brain injury (3%), air pollution (3%), physical inactivity (2%), diabetes (2%) hypertension (2%), smoking (2%), obesity, (1%), untreated vision loss (2%) and excessive alcohol consumption (1%). Based on the TILDA study, 70% of Irish adults (> 50 years) have four modifiable risk factors with a higher number in those with greater cognitive decline over a 12 year period. This has led to focus on promoting ‘brain health’ though the life-course to reduce the risk of AD by addressing the above factors, including adequate treatment of hypertension, high cholesterol and diabetes. Other risk factors for AD may include sleep disturbance and viral infections (HSV-1, VZV and influenza) with studies suggesting that vaccination against flu and shingles may be protective.

Aetiopathology The pathological changes of AD were first described in 1906 by Alois Alzheimer and include plaques and tangles in the brain. In the 1980’s, it was discovered that plaques contain extracellular insoluble aggregates of β-amyloid while tangles comprise intracellular hyperphosphorylated tau. The amyloid cascade hypothesis in the 1990’s proposed that amyloid plaques are the primary pathology with downstream deposition of tau. It is now believed that these early brain changes may predate the diagnosis of AD by decades, though the precise tiggers are unknown. Risk factors Several factors appear to influence AD risk. While the biggest risk factor is age, the Lancet Commission identified

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Genetic factors are important in some patients, with a higher likelihood with a positive family history, especially when two 1st degree relatives. Notably, homozygous carriers of the Apo-E4 allele (1-3% of the population) have a tenfold higher risk. Monogenetic

In most patients, the initial symptom is memory loss, primarily due to involvement of the hippocampus, which normally lays the trace for new memory. This results in the inability to save new memories, poor or absent recognition memory and often repetitive questioning. Difficulty with naming and wordfinding are also common early on due to temporal lobe disease. This pattern of rapid forgetfulness is typical of AD as distinct from more patchy cognitive deficits due to other causes of dementia. Over time multiple cognitive domains become impaired. A minority of patients have atypical presentations, though this is more common (33%) in those under 65 while only occurring in 6% over 65. These include deficits in language (logopaenic variant of primary progressive aphasia), behavioural / dysexecutive (frontal AD), visuospatial function (posterior cortical atrophy) or motor domains (corticobasal syndrome). While associated with diagnostic delays and misdiagnosis, even in typical cases the time from symptom onset to diagnosis is often several years with underdiagnosis common. Diagnosis Diagnosis of AD is based on a (1) history of cognitive decline, (2) objective evidence of cognitive impairment on testing (usually with an AD profile), (3) exclusion of other causes (4) biomarker evidence of disease and/or functional impairment. In the early stages, patients may have no impairment in function and may be diagnosed with mild cognitive impairment due to AD (MCIAD). As the disease progresses, there is functional decline and subsequently Alzheimer’s dementia. In clinical practise, most patients with AD have dementia at the time of diagnosis, though

in those with MCI-AD, a diagnosis can be made using biomarkers. MRI brain is the first line imaging modality for suspected cases of AD. In typical AD, there is often early hippocampal atrophy followed by atrophy of the medial temporal lobe and parietal lobe. MRI is also sensitive at detecting the burden of co-existent cerebrovascular disease though CT brain with coronal cuts of the hippocampi is a reasonable alternative for structural imaging. Biomarkers In general, biomarkers can be used to confirm a diagnosis in (1) patients with probable AD or MCI due to AD (MCI-AD), (2) unexplained and persistent MCI, (3) in patients below 65 when AD is suspected and (4) for atypical presentations that could be due to AD. The decision to pursue a biological diagnosis is made on case by case basis, factoring in patient preference and gives diagnostic certainty as well as being key in determining eligibility for disease modifying drugs. It also allows for an early diagnosis and future planning, with the progression from MCI-AD to Alzheimer’s dementia usually taking about 2-5 years. Cerebrospinal fluid (CSF) biomarkers are considered the most sensitive and first line test for a biological diagnosis. The typical CSF profile is a reduction in β amyloid-42 (which remains trapped in plaques in the brain) and an increase in tau that is released from diseased neurones and passes into the CSF. Total tau can be raised from other causes of neuronal death (e.g., stroke or CJD) whereas p-tau 181 is more specific to AD. A high p-tau 181/ β amyloid-42 ratio corelates highly with pla que disease and has diagnostic sensitivity of approximately 90% and specificity of 85-90%. Amyloid PET detects amyloid plaques in vivo and has high concordance with CSF biomarkers and similar diagnostic accuracy. However, it is expensive, less accessible and may be negative in the earlier stages of disease. It should therefore, only be used when CSF-AD biomarker testing is contra-indicated or not possible. A blood test to detect early AD

83 administered intravenously every 2 weeks over 18 months was shown to slow the progression of disease by about 4-6 months or reduce cognitive decline by 27%. However, the absolute difference in the primary clinical outcome was small. Donanemab is administered intravenously once monthly and has similar efficacy over 18 months. An extension study over 18 months post donanemab therapy showed continued reduction in cognitive decline and similar safety profile. It also included a cross-over group who started therapy in the second 18 months. Those who started early therapy were less likely to progress at 3 years suggesting that early diagnosis and therapy is preferable. An open label study of lecanemab with follow up at 48 months also suggests sustained slowing of cognitive decline. While a Cochrane review in 2026 judged the effect of anti-amyloid therapies as small and uncertain, it included five other drugs (which were less effective, had different mechanistic actions and are now discontinued).

approved in Europe in May of this year measures serum p-Tau -217, which when elevated indicates amyloid pathology in the brain. Diagnostic accuracy is comparable to CSF biomarkers. This marks a new landmark in AD diagnostics, allowing for noninvasive and convenient testing and with greater access in Ireland likely in the near future. FDG-PET assesses regional hypometabolism and non-specific neurodegeneration and is positive prior to developing brain atrophy. While not a biomarker of amyloid, hypometabolism in the posterior cingulate, precuneus and temporal lobe is highly suggestive of AD. Dementia Management There is no cure for AD but good management can transform how a person lives with the disease. Although disease-modifying treatments are emerging, they remain at a nascent stage and at present are only suitable for a minority of patients. The

cornerstone of care is personcentred and individualised — future planning, communication, social care and family support and preserving dignity and personhood. Traditional pharmacological approaches In mild-to-moderate Alzheimer’s dementia, cholinesterase inhibitors (donepezil, rivastigmine and galantamine) are the mainstay of therapy giving modest gains in cognition and function— a 2 to 4 points benefit on the 70-point ADAS-Cog over six months in trials but do not alter disease course. They commonly (15%) cause gastrointestinal upset which is less frequent with the transdermal rivastigmine patch and is preferred in such cases. Donepezil is taken once daily and is most commonly used. Bradycardia and syncope are rare adverse effects and their use is contra-indicated in the presence of a low heart rate (< 5060 bpm) and cardiac conduction defects. For this reason, an ECG should be considered before use.

Memantine, an NMDA-receptor antagonist is used in moderate-tosevere disease either alone or in combination with a cholinesterase inhibitor and modestly reduces decline in cognition and function. Both medications are approved for Alzheimer’s dementia but not for MCI-AD where no benefit has been observed. However, trials predated amyloid and tau biomarkers and included aetiologically heterogeneous MCI rather than biomarker-confirmed AD. Disease-modifying anti-amyloid therapies Anti-amyloid monoclonal antibodies have drawn intense interest as disease-modifying treatments. Lecanemab and donanemab were EU-approved in 2025 for the treatment of MCIAD or mild Alzheimer’s dementia with biomarker confirmed amyloid. Both are shown to reduce cerebral amyloid and result in a modest reduction in cognitive and functional decline. Lecanemab which is

The main adverse effects are amyloid-related imaging abnormalities (ARIA) which include oedema (13.0–26.7%) and microhaemorrhage (17.0–31%) and is more common with donanemab. Most ARIA occur initially in the first 3-6 months, are mild or moderate and asymptomatic but 1-2% have serious events. For this reason, serial MRI surveillance is required involving 4 or more scans as determined by protocol. When asymptomatic or mild, therapy is continued though when moderate to severe or if symptomatic (3-6%) is usually stopped. Patients who are ApoE4 homozygotes have a high risk of ARIA where treatment is contraindicated. Administration is demanding on healthcare services with regular intravenous infusions. Prior to treatment there must be AD biomarker confirmation and ApoE genotyping. New blood biomarkers and development of subcutaneous formulations may reduce this healthcare burden. Under current criteria, it is estimated that only 15% of MCI or mild AD cases would qualify. In Ireland, these drugs are currently not reimbursed but at the time of writing, access is facilitated privately at one Irish hospital. The drug cost to patients is in excess of ¤30,000 per annum, though administration and monitoring bring total expense to about ¤60,000, with these additional non-drug costs covered by some Irish health insurers. While drug assessment is underway in Ireland, in the UK both therapies were rejected in 2025 for the NHS by NICE on

IRISHPHARMACYNEWS.IE

Alzheimers Disease

cost-effectiveness grounds. Irish specialist services have begun working on infrastructure and care pathways needed should these drugs become reimbursed and publicly available. While still at an early stage, these drugs provide a realistic prospect that for some patients, AD may become a condition whose course can be slowed, not only supported. Beyond medication: non-pharmacological and community support Every person with AD is affected differently, so care must be individualised, with nonpharmacological, person-centred measures as its foundation. Communication and education are essential: everyone diagnosed should be counselled on the diagnosis, prognosis and advised on the supports available. Cognitive stimulation therapy has the best evidence in mildto-moderate AD dementia, producing cognitive and qualityof-life gains comparable to

the cholinesterase inhibitors. Occupational therapy interventions and Memory Technology Resource Rooms (through the Alzheimer Society) help sustain activity and independence — memory aids, home labelling and reminders, and assistive technology such as automatic pill dispensers and location trackers. Other measures include regular physical activity, a predictable routine, correcting sensory impairment with hearing aids and glasses, personalised music and reminiscence and attention to nutrition and sleep. Dementia rarely occurs in isolation — comorbidities, polypharmacy and progressive impairment of mobility, swallowing, continence and daily activities all demand coordinated multidisciplinary input. Family carers are central and supporting them is among the most effective interventions: carer-directed programmes reduce neuropsychiatric symptoms and carer distress and can delay institutionalisation. The Alzheimer Society provides family-carer

training, peer support groups, a national helpline, Alzheimer cafés, dementia advisers, day care and respite. As dementia is progressive, planning ahead is vital. Patients should be supported to plan early and to consider making a will, putting an enduring power of attorney in place and recording an advance healthcare directive. In the later stages, comfort and dignity take priority over potentially harmful or futile interventions and high-quality palliative care should be available. Managing non-cognitive symptoms of dementia (NCSD) NCSD includes agitation, aggression, wandering, psychosis, apathy, sleep disturbance and affects almost every patient in their AD course and predicts institutionalisation more strongly than severity of cognitive impairment. The first step is to seek a precipitant: pain, infection, constipation, urinary retention, delirium, depression, sensory

deprivation or an unfamiliar setting. The DICE approach — Describe, Investigate, Create, Evaluate is a useful framework for managing these symptoms. Antipsychotics should only be considered when the patient has severe distress, psychosis and/ or there is at risk of harm. Their indication should be clearly documented and the lowest dose used for the shortest duration possible. In Ireland, risperidone is the only antipsychotic licensed for use in dementia with therapy approved for up to 6 weeks. In clinical practise, patients often need a much longer duration of treatment. However, their efficacy is modest and harms are well documented — increased risk of stroke, venous thromboembolism, pneumonia, worsening cognitive impairment and fractures . They also have an FDA black-box warning due to an observed 1.5 to 1.7-fold increase in mortality in dementia patients. References available on request

Date for your Diary The PMI will host a Stakeholder Briefing breakfast on 10 September 2026, providing attendees with an update on recent initiatives from the HSE Medicines Management Programme (MMP). Taking place at the Clayton Hotel, Liffey Valley, Dublin 22, from 7.30am to 9.30am, the briefing will welcome Bernard Duggan and Dr Claire Gorry from the HSE Medicines Management Programme team. The session will focus particularly on the Best Value Biologics (BVB) process and its implementation, alongside an overview of the Managed Access Protocol (MAP) and the High Tech Arrangement. The breakfast briefing provides stakeholders with an opportunity to hear directly from the MMP team about current developments and initiatives within these important areas of medicines management. The event is supported by IQVIA. PMI members can book through the organisation's website, while non-members interested in attending are advised to contact the PMI office directly.

IRISHPHARMACYNEWS.IE

CPD -- Automation Automation Continuing Professional Continuing Professional Development Development

CPD CPD

Author:John MPSI isisOwner Ownerand andSuperintendent Superintendent Pharmacist Author: John Green Green MPSI Pharmacist at at Poppintree Pharmacy Ballymun, Dublin, over 20 years’ Poppintree Pharmacy in in Ballymun, Dublin, with with over 20 years’ experience experience community pharmacy. in communityinpharmacy. His practicefocuses focuses intersection of workflow design, His practice onon thethe intersection of workflow design, robotics robotics and clinical service delivery in community pharmacy. His signature belief and clinicalsystems servicecreate delivery in community pharmacy. His signature that strong strong pharmacies shapes his approach to belief that design, strong systems create and strong his in dispensary staffing structure the pharmacies deployment ofshapes technology approach to dispensary support of patient care. design, staffing structure and the deployment of technology in support of patient care.

•Community pharmacy

is undergoing structural 60 Second Summary change through the Community Pharmacy • Community pharmacy Agreement 2025,structural the is undergoing Common change Conditions through theService and digitalisation. Community Pharmacy Agreement 2025, the • Rising volumes, workforce Common Conditions constraints and expanding Service and digitalisation. clinical responsibilities are creating capacity • Rising volumes, workforce pressures sector wide. constraints and expanding clinical responsibilities • Dispensing are creatingautomation capacity frees pharmacist pressures sectorand wide. technician time, improves stock control automation and • Dispensing strengthens patient safety. frees pharmacist and technician time, improves • Evidence fromand Poppintree stock control Pharmacy shows strengthens patient safety. measurable gains in workflow, • Evidencestock from and Poppintree service delivery following Pharmacy shows robotic dispensing measurable gains in installed with a full workflow, stock and dispensary redesign. service delivery following robotic dispensing installed with a full • The most valuable dispensary redesign. outcome is not faster dispensing but clinical • The most valuable capacity that pharmacists outcome is not faster can redirect toward patient dispensing but clinical care. capacity that pharmacists can redirect toward patient care.alone does • Automation not deliver these • Automation alone does outcomes. not deliverWorkflow these redesign, staffing outcomes. Workflow structure and change redesign, staffing the management make structure and change technology work. management make the

technology work.

knowledge gap--will willthis this article satisfy 1. readingthis this knowledge gap article satisfy 1. REFLECT REFLECT -- Before Before reading needs--or orwill willmore more reading module, considerthe thefollowing: following: those needs reading module, consider WillWill thisthisthose clinical areabe berelevant relevant practice? be be required? required? clinical area to to mymy practice? 4. EVALUATE - Did this article 2. IDENTIFY - If the answer is no, 4. EVALUATE - Did this article 2. IDENTIFY - If the answer is no, meet my learning needs - and how I may still be interested in the area meet my learning needs - and how I may still be interested in the area has my practise changed as a but the article may not contribute has my practise changed as a but the article may not contribute result? Have I identified further towards my continuing professional result? Have I identified further towards my continuing professional learning needs? development (CPD). If the answer is learning needs? development If the is yes, I should(CPD). identify anyanswer knowledge 5. WHAT NEXT - At this time you may yes, I in should identify area. any knowledge 5. WHAT NEXT - At this time you may gaps the clinical like to record your learning for future gaps in the clinical area. like to your learning forthe future use orrecord assessment. Follow 3. PLAN - If I have identified a 3. PLAN - If I have identified a use or assessment. Follow the

logand and record 44 previous steps,log previous steps, record your findings. your findings. Published byIPN. IPN. Published by Copies canbe bedownloaded downloadedfrom from Copies can www.irishpharmacytraining.ie www.irishpharmacytraining.ie

Disclaimer: All material published is Disclaimer:no All part material published copyright, of this can beisused in any copyright, no part of this can be used inof any other publication without permission the other publication withoutBD permission of the publishers and author. Rowa has publishers author. of BDthe Rowa no editorialand oversight CPDhas programmes no editorial of the CPD programmes included in oversight these modules. included in these modules.

Creating Capacity for the the Future Future of Community Community Pharmacy Pharmacy How dispensing automation can support Ireland’s evolving evolving clinical pharmacy model Introduction: Community Introduction: Community pharmacy at at a crossroads pharmacy a crossroads Community pharmacy in Ireland Community pharmacy in Ireland is being asked to do more, faster, is being asked to do more, faster, with fewer people. The Community with fewer people. The Community Pharmacy Agreement 2025 and Pharmacy Agreement 2025 and the Common Common Conditions ConditionsService, Service, the launched at at the the end end of of January January launched 2026, have have widened widened the the clinical clinical 2026, remit to to assessment, assessment, treatment treatment remit and prescribing prescribing for for an an initial initial eight eight and conditions. ItItisis the themost mostsignificant significant conditions. expansion of of the the community community expansion pharmacy role role in in over over aa decade. decade. pharmacy The operational operational picture picture is is more more The difficult. The The PCRS PCRS reimbursed reimbursed difficult. over 105 105 million million items items in in 2024, 2024, over up 6.5% 6.5% on onthe theprevious previous up year. Medicine shortages consume management management time, time, consume recruitment remains remains difficult, difficult,and and recruitment administrative administrative demands demands keep keep growing. growing. Approximately Approximately6% 6%ofof pharmacies pharmacies operate operate at at aa loss loss and and a further further 31% 31% on on low lowmargins, margins, leaving leaving little little headroom headroom to to absorb absorb additional additional workload workloadfrom froman an unchanged unchanged operating operating base. base. The question question this this creates creates for for pharmacy pharmacy owners owners is is direct. direct.

One step ahead. Always. Forever. Here’s to 30 years of the future. Scan the QR code to explore what’s possible for your pharmacy

How How do do we we generate generate the the capacity capacity to the next next phase phase of of to deliver deliver the pharmacy while pharmacy services services while continuing to dispense dispense aa rising rising continuing to volume of medicines medicines safely? safely? volume of

condition conditionthat thatchanges changeshow howthe the question question should should be beapproached. approached.The most important aspect of a modern The most important aspect of a pharmacy is the system runs it. modern pharmacy is thethat system Robotics is the foundation the that runs it. Robotics is the system is built on, not the system foundation the system is built on, Pharmacies that buy a robot For many pharmacies, pharmacies, automation automation is itself. not the system itself. Pharmacies get a faster dispensary. Pharmacies part of the answer. Robotic is part of the answer. Robotic that build buy a robot get a faster that dispensing dispensing systems systems have have dispensary. thatget build a system on Pharmacies that foundation a existed for years but their role in existed for years but their role in a systembusiness. on that foundation get a different community pharmacy is shifting. community pharmacy is shifting. different business. Historically Historically viewed viewed as as aa tool tool for forhighvolume dispensing alone, Why capacity is defining the Why capacity is the high-volume dispensing alone, automation is now increasingly defining challenge challenge automation is now increasingly considered as an enabler of consideredsustainability, as an enablerclinical of workforce Conversations about about automation automation Conversations workforce sustainability, clinical service expansion and operational often start with efficiency. often start with efficiency. Efficiency, service expansion and operational resilience. This CPD article draws Efficiency, on its own, isprimary rarely on its own, is rarely the resilience. This CPD article draws on the experience of an Irish the primary primary Theproblem. primary The problem is on the experience of an Irish community pharmacy that installed a problem. problem is capacity. capacity. community pharmacy that installed BD Rowa robotic dispensing system a BD robotic dispensing as partRowa of a broader dispensary A pharmacist in a busy A pharmacist in a busy community system asand partasks of a abroader redesign, bigger community pharmacy covers pharmacy covers several dispensary redesign, and asks a question than “does the robot several categories of work categories of work simultaneously: dispense faster?”than “does the bigger question simultaneously: high-volume high-volume dispensing, medicine robot dispense faster?” dispensing,vaccinations, medicine shortages, shortages, patient and Can automation help create vaccinations, patientconsultations, and common conditions Cancapacity automation help create need common the Irish pharmacists conditions consultations, management, and stock thefulfil capacity Irish pharmacists to their expanding clinical role? stock management, and supervision supervision need to fulfil their expanding of technicians technicians and and support supportstaff. staff. of clinical role? My answer, after a full year of Each difficulty Each has value. The is operation, is yes, but with a that they they all all draw draw on on the the same same finite that My answer, after a full year of resource: professional time. time. operation, is yes, but with a finite resource: professional

87 Rising demand was once Rising demand wasWorkforce once by hiring. absorbed absorbed by hiring. Workforce shortages have closed that route shortages have closed that route in many locations. The Pharmacy in many locations. TheReport Pharmacy Workforce Intelligence is Workforce Intelligence Reportand is clear that process innovation clear that process innovation and digital solutions must sit alongside digital solutions sitisalongside recruitment if themust sector to remain recruitment if the sector is to sustainable. Automation, on that remain sustainable. Automation, on reading, is not a technology project. that reading, is not a technology It is a workforce strategy. project. It is a workforce strategy. The purpose of automation is not to The purpose of replace pharmacists. It isreplace to release automation is not to their time so they the pharmacists. It can is todeliver release clinical work so only theycan aredeliver qualified their time they tothe do.clinical work only they are qualified to do.

Looking beyond faster Looking beyond faster dispensing dispensing

One misconception about robotic dispensing is that itabout existsrobotic to One misconception dispense more prescriptions dispensing is that it exists to faster. Higher dispense moredispensing prescriptions throughput is dispensing a genuine outcome, faster. Higher but framingisautomation that way throughput a genuine outcome, undervalues it. Four broader but framing automation that way questions matter more in undervalues it. Four broader evaluating any automation project. questions matter more in evaluating any project. Howautomation well will the system integrate with existing pharmacy How well will the system integrate software? with existing pharmacy software? Integration is the difference between a robot that removes Integration is the difference work and one that adds it. between a robot that removes work and one What willit.it do to stock that adds management? What it do to stockexpiry Stock will control (including management? Stockrotation control and checks, stock levels, (including stock ordering) isexpiry one ofchecks, the most time levels, rotation andinordering) is one intensive activities community of the mostand timeone intensive activities pharmacy of the least in community and one visible. A robotpharmacy that captures every of the least visible. A goods robot that pack’s expiry date at in captures every pack’s expiry date at and enables first-expiry-first-out goods in and enablesstock first- control expirydispensing changes first-out dispensing changes stock from a periodic manual exercise control from a periodic manual one. into a continuous informational exercise into a continuous How much capacity will it informational one. actually free? How much capacity will Vendor specifications quote packs it actually free? Vendor speeds. per hour and dispensing specifications packsThe permore Those figures quote are useful. hour and dispensing meaningful figure forspeeds. pharmacy ownersfigures is howare many hours of more Those useful. The pharmacist figure and technician time are meaningful for pharmacy freed per and what owners is week, how many hourshappens of to those hours pharmacist andnext. technician time are freed week, workforce and what happens Will itper improve to those hours next. resilience?

A pharmacy thatworkforce runs at 100% Will it improve staff capacity functionthat loses resilience? A to pharmacy runs at servicestaff capacity every time 100% capacity to function loses someone is off sick or time a locum service capacity every cannot beisfound. Automation someone off sick or a locum reducesbethat dependence. cannot found. Automation reduces that dependence.

From automation project to no no more more and and no no fewer. fewer. IfIf there there is is From automation project to no workstation, there isisno post; no workstation, there no post; pharmacy transformation pharmacy transformation if the workflow needs another The reason automation projects The reason automation projects underperform is that they are underperform is that they are treated treated as technology projects as technology projects rather than rather than transformation transformation projects. Theprojects. robot is The robotinto is installed into an installed an unchanged unchangedrunning dispensary running dispensary an unchanged unchanged workflow, workflow, and andthe the an return is is aa fraction fraction of of what whatititcould could return be. The The evidence is consistent consistent be. on this this point: point:robotic roboticdispensing dispensing on delivers delivers most most of of its itsvalue value when when installed installed as as part part of of aa workflow workflow redesign, redesign, not not on on top topof ofone. one.

if the workflow needs another person, person, aa workstation workstationisisadded addedfirst first and the person second. The rule and the person second. The rule sounds administrative. It is not. It sounds administrative. is not. It is the system expressedItas a hiring is the system as a hiring policy, and it isexpressed the mechanism policy, and it the is the mechanism that stopped cycle of marginal that stopped thethat cycle of volume marginal short-term hires high short-term hires that high volume pharmacies are structurally exposed pharmacies are structurally to. exposed to.

pharmacist pharmacist and and 4.0 4.0 technician technician FTE. The pharmacists pharmacists now FTE. The now also also spend spend aa materially materially larger larger share share of of their their working workingday dayon onpatient patient consultations and clinical activity. consultations and clinical activity. Automation is not measured by how Automation is not measured by much work the machine how much work the machine does. It is measured by what the does. It is team measured what pharmacy does by with the the time pharmacy team does with the time the machine has released. the machine has released. Stock management Stock management

Stock Stock on on hand handreduced reducedby by approximately approximately 48%, 48%,and andout-ofout-ofstock stock incidents incidentsfell felldramatically dramaticallywith the that some out ofout stock withcaveat the caveat that some of The full full impact impact of of automation automation The are beyond the control of stock are beyond the control of At Poppintree Pharmacy in only becomes becomes visible visible after after aa At Poppintree Pharmacy in only the Pharmacy. Holding less stock the Pharmacy. Holding less stock Ballymun, we we installed installed aa BD BD Ballymun, sustained period period of of operation. operation.At At sustained while stocking out less often runs while stocking less often runs Rowa™ Rowa™ Vmax Vmax 160 with with BD BD Rowa™ Poppintree Poppintree we we now now have have aa full full against intuition,out and that counter EasyLoad automated goods-in unit year against intuition, and thatHigher counter Rowa™ EasyLoad automated year of of data data and and the the outcomes outcomesfall fall intuition makes the point. in May 2025 a wider intuition makes theimprove point. Higher goods-in unitasinpart Mayof2025 into four four categories. categories. into stock levels do not dispensary The redesign stock levelsbetter do not improve as part of arebuild. wider dispensary availability, information Workflow efficiency efficiency covered the full dispensary availability, better information Workflow rebuild. The redesign covered does. Barcode verification, expiry refurbishment, reconfiguration of does. Barcode capture at input verification, and usage- expiry the full dispensary refurbishment, The most immediate effect was the workstations, workflow redesign The most immediate effect was the capture at inputhas andshifted usage-stock ordering reconfiguration of workstations, reduction in repetitive manual tasks based around a central checking island, reduction in repetitive manual tasks control from periodic estimation to based ordering has shifted stock workflow redesign around a and staff staff movement. movement. Observational Observational staff training and upskilling, change and continuous with to control fromlivestock periodiccontrol estimation central checking island,and staff analysis showed showed an an approximately approximately management planning, ongoing analysis actual patient demand. continuous livestock control with training and upskilling, 80% reduction reductionininwalking, walking,from from performance monitoring.change The 80% actual patient demand. management planning, and pharmacy team was central around 5,050 5,050 steps steps per per person person per per around Patient safety ongoing performance monitoring. throughout. New technology day to to around around 1,050. 1,050. Walking Walking looks looks Patient safety day The pharmacy team was central in any workplace generates trivial until until itit is is measured. measured. In In aa highhigh- Published error rates for fully trivial throughout. Will Newittechnology uncertainty. create more Published error rates range for fullyfrom volume dispensary dispensary itit consumes consumes volume manual dispensing in any Will workplace generates work? it be reliable? Will manual dispensing aa large share of the working working day day and approximately 1% range to 2%;from patients suffer during rollout? uncertainty. Will it create moreHow approximately 1% to 2%; barcodeinterrupts the concentrated tasks barcodecontrolled robotic and interrupts the concentrated will roles change? work? Will it be reliable? Will controlledreport roboticrates systems report that generate errors errors when when systems below tasks that generate Addressing those questions early, patients suffer during rollout? How interrupted. rates below 0.01%. AtPharmacy Poppintree Steps taken must be 0.01%. At Poppintree interrupted. Steps taken must be honestly with the team rather will rolesand change? Addressing calculated Pharmacy theoffirst year of across the across first year dispensing calculated as as monetary monetary value, value, as as than the team,early, turnedhonestly out to be unneeded thoseatquestions dispensing we can this rate we can confirm thisconfirm rate is reflective unneeded movements movements will will weigh weigh the single most important on lost margin. of our own dispensing One and with the team rather than at is reflective of our owndata. dispensing on lost margin. determinant of whether project year oneyear pharmacy is not a is the team, turned out to the be the data.atOne at one pharmacy succeeded. controlled trial, but the finding is Workforce capacity capacity single most important determinant Workforce not a controlled trial, but the finding consistent with thethe published of whether the project succeeded. is consistent with published One design decision deserves Despite rising rising patient patient demand demand Despite literature materially better better than than literature and and materially particular attention I have and the addition addition ofnew new clinical the clinical One design decision deserves manual comparator. dispensing we canbecause confirm thisWe rateand is reflective of of our own dispensing the data. One year at one pharmacy the manual comparator. not seen it described elsewhere. services, services, the the pharmacy pharmacy now now particular attention because I have adopted aitrule that the dispensary is not a controlled trial, but the finding is consistent with dispensary the published literature and materially better operates with operates with aa smaller smaller dispensary not seen described elsewhere. employs the number of staff for team. Pre-installation the team was team. Pre-installation the team was We adopted a rule that the Figure 1:Poppintree Poppintree Pharmacy than the manual comparator. which it has workstations, Figure 1: Pharmacy 3.0 3.0 pharmacist pharmacist and and 5.5 5.5 technician technician dispensary employs the number of outcomes following automation outcomes following automation FTE; post-installation itit isis 2.5 staff for which it has workstations, FTE; post-installation 2.5

Measuring success: Measuring success: what what changed changed

Figure 1: Poppintree Pharmacy outcomes following automation Before automation Before

After After automation automation

Pharmacist Pharmacist FTE FTE

3.0

2.5 2.5

Technician Technician FTE FTE

5.5

4.0 4.0

Stock Stock holding holding

Baseline

−48% −48%

Out-of-stock Out-of-stock incidents incidents

Baseline

Dramaticallyreduced Dramatically reduced

Staff Staff walking walking

~5,050 ~5,050 steps/day steps/day

~1,050 ~1,050 steps/day steps/day

Picking Picking errors errors

to 2% 2% published published for for manual manual 11 to dispensing

Below 0.01% 0.01% -- Confirmed Confirmed

Clinical Clinical services services

Existing service range

Full Full CPA CPA 2025 2025 and and CCS CCS delivery delivery

Outcome Outcome

Automation and the expansion of clinical services The finding most relevant to Irish pharmacies is not any single metric. It is what became possible with the freed time. The Common Conditions Service is a substantial step forward, but delivering consultations requires pharmacist time, and without operational redesign the new clinical services are simply added to a workforce that is already stretched.

88 CPD - Automation 88 CPD - Automation

• •Measure the right outcomes. CCSclinical clinicalservice servicerange rangewith witha a Automation and thethe expansion of CCS Measure the right outcomes. Automation and Focus on patient experience, clinical services reduced team as described above. team as described above. reduced Focus on patient experience, expansion of clinical capacity, capacity,service servicedelivery deliveryand and Thisisisthe theoutcome outcomethat thatmatters, matters, This The finding most relevant to Irish services stock stockcontrol, control,not notdispensing dispensing theintervention interventiondid didnot not substitute the substitute pharmacies is not any single machinecapacity capacityforforlabour labourcost. cost. machine metric. It is what became The finding most relevant topossible Irish It enabled the expansion of clinical It enabled the expansion of clinical with the freed time. Common pharmacies is not anyThe single servicerange rangewithout withoutexpanding expandingthe Conditions Service is a possible substantial service metric. It is what became the workforce. In a sector where workforce. In a sector where step but The delivering with theforward, freed time. Common workforce cannot readilybebe cannot readily consultations requires pharmacist workforce Conditions Service is a substantial expanded,that thatis isthe thepractical practical expanded, time, and without operational step forward, but delivering resolutiontotothe thesectoral sectoralpressure. pressure. resolution redesign therequires new clinical services consultations pharmacist time, without operational are and simply added to a workforce Lessons for pharmacy owners redesign the newstretched. clinical services that is already Lessons for pharmacy are simply added to a workforce that Five lessons emerged. owners offers an alternative. is Automation already stretched. At Poppintree Pharmacy • Budget for the redesign, not the pharmacists now spend Fivethe lessons robot emerged. alone. The workflow Automation offers an alternative. more of their week on • Budget redesign, not rebuildfor is the a material investment, At meaningfully Poppintree Pharmacy Conditions consultations, theand robot alone.depends The workflow the return on it. theCommon pharmacists now spend vaccinations, medicines rebuild is a material investment, meaningfully more of their week on •and Engage the depends team early. optimisation, patient counselling, the return on it. Common Conditions consultations, Adoption depends on staff adherence support and longvaccinations, medicines • Engage the team early. early confidence, built through term condition management. optimisation, patient counselling, conversation, training and visible The pharmacy delivers the full Adoption depends on staff adherence support and longservices outlined in CPA 2025 and responsiveness to concerns. term condition management. built through early confidence, The pharmacy delivers the full conversation, training and visible services outlined in CPA 2025 and responsiveness to concerns.

Technology Technology that that takes takes the the Technology that takes the pressure pressure off, off, so so your your team team can can pressure off, so your team can focus focus on on care care focus on care

speed speedalone. alone.

• •Think strategically. Think strategically.Automation Automation shouldsit sitinside insideaalonglongshould term termoperating operatingvision visionfor forthe the pharmacy, pharmacy,not notsolve solveaashortshortterm termbottleneck. bottleneck. Plan the deploymentofofthe the • •Plan the deployment freedcapacity. capacity.Creating Creating freed capacityisisonly onlyvaluable valuableififitit capacity deliberatelyredirected redirected isisdeliberately toward towardpatient patientcare careand and funded fundedservices. services. Choosing the right Choosing the right automation system automation system

Selecting a dispensing robot is a Selecting dispensingdecision, robot is a long-termaoperational operational decision, long-term not a purchase of equipment. purchase of equipment. not Thea robot becomes mission- The robot becomes mission-

critical criticalinfrastructure infrastructurewithin withinthe the dispensary, dispensary, so so reliability, reliability, service support supportand andintegration integrationmatter matteras as much muchas as technical technical specifications. specifications. When When we we evaluated evaluated systems, we looked lookedfor foraa proven proven track trackrecord record in in pharmacy pharmacy automation, automation, clean clean integration integration with withour ourmanagement management system, system, local local service service and and technical technical support, support,and andevidence evidenceof of experience experience across across implementation, implementation, training training and and optimisation. optimisation.In In our our case case those those criteria criteria led led us us to to the the BD BD Rowa™ Rowa™ Vmax Vmax 160 and BD Rowa™ EasyLoad. EasyLoad. The The system has performed performedas as specified specified over over the the first year and the support first year andimplementation the implementation during the rebuild central support during thewas rebuild wasto a smooth transition. The general The central to a smooth transition. principle is to evaluate the fit the general principle is to evaluate between thethe system andand thethe fit between system pharmacy’s pharmacy’s operations operations weighing weighing service service capability capability alongside alongside technical technical performance. performance.

BD BDRowa™ Rowa™EasyLoad EasyLoad ––the the fully fullyautomatic automatic BD Rowa™ EasyLoad input input system system ofofthe the – the fully automatic new newgeneration generation input system of the

new generation

89 Where this goes nextnext Where this goes The case for building systems The case for building systems on automated foundations on automated foundations strengthens from here. Ireland’s strengthens from here. Ireland’s national e-prescribing programme national e-prescribing programme is is scheduled to go live in late scheduled to go live in late 2027, with widespread adoption 2027, with widespread adoption expected through through 2028. 2028. When When expected prescriptions arrive digitally, the prescriptions arrive digitally, the pharmacies best best placed placed to to benefit benefit pharmacies will be be those those whose whose dispensing dispensing will operation is is already already digital digital end end to to operation end with with barcode barcode verified verified storage, storage, end informational stock stock control, control,and and informational workflow designed designed around around data data workflow rather than paper. Automation today is is not not just just aa installed today productivity investment, investment, ititisisthe the productivity infrastructure layer for the digital digital pharmacy that that Irish Irish primary primary care care policy is now now building building toward. toward.The The pharmacies that treat treat the the next next two two years as preparation time will meet e-prescribing e-prescribing as as an an opportunity, opportunity, those those that that do do not not will will meet meetititas as another another pressure. pressure.

Conclusion Conclusion

CPD Reflection BoxBox CPD Reflection

References References

Community pharmacy is entering

Consider the following questions Consider the following questions in relation to your own practice. in relation to your own practice. 1. How 1. How much much pharmacist pharmacist time time in your in your pharmacy pharmacy is is currently currently spent on on non-clinical spent non-clinical activities? activities?

1. Primary PrimaryCare CareReimbursement Reimbursement Service. Annual Report 2024. Health Service Executive.

Community pharmacy is entering a more moreclinical, clinical,more more digital a digital andand more integrated integratedphase. phase. Meeting more Meeting its its expectationsrequires requires sustainable expectations sustainable capacity existing workforce capacitywithin within existing workforce constraints, the Poppintree constraints,and and the Poppintree experience dispensing experiencesuggests suggests dispensing automation a material automationcan canbebe a material part of that solution. The broader part of that solution. The broader point extends beyond robotics: point extends beyond robotics: the biggest gains come when the biggestworkflow gains come when technology, design, team technology, and workflow design, engagement leadership alignteam around the same engagement andobjective. leadership align

around the same objective.

Automation is not, in the end, Automation is not, in the about dispensing more medicines. It is about creatingmore the end, about dispensing time, space and for medicines. It iscapacity about creating pharmacists to deliver care the time, space and the capacity that increasingly need for patients pharmacists to deliver the and expect. care that patients increasingly On thatand reading, it is On not that an need expect. operational investment. It is an reading, it is not an operational investment in the future role of investment. It is an investment community pharmacy itself.

in the future role of community pharmacy itself.

2. What operational operational bottlenecks bottlenecks most frequently affect patient most frequently affect patient waiting times? waiting times? 3. How much stock is currently held in your dispensary, dispensary, and and what proportion turns over in a given month? 4. If pharmacist consultation activity doubled, doubled, could couldyour your current workflow support support it? it? 5. Is your dispensary dispensary designed designed around people moving to medicines, or medicines moving to people? 6. What characteristics would would you consider most important automation when selecting an automation system?

2. Department DepartmentofofHealth. Health. Minister for for Health Health publishes publishes Community Community Pharmacy Pharmacy Agreement 2025. Government of Ireland, 2025. 3. United UnitedDrug. Drug.Common Common Conditions Service: the expanding Conditions Service: the of community in role expanding rolepharmacies of community Ireland. 2025. in Ireland. 2025. pharmacies

4. EY EYIreland. Ireland.What Whatwill willenable enablethe 4. nextofphase of pharmacy nextthe phase pharmacy practice practice2026. in Ireland? 2026. in Ireland? 5. Elliott ElliottRA, RA,Camacho CamachoE,E, Jankovic D, et al. Economic Economic analysis of the prevalence and clinical and economic economic burden burden of medication error in England. of medication error in England. BMJ Quality & Safety, 2021. 6. Takase Takase T, T,et etal. al.Evaluating Evaluatingthe the safety and and efficiency efficiency of of robotic robotic safety dispensing systems. systems. Journal Journal dispensing of Pharmaceutical Pharmaceutical Health Health Care Care of and Sciences, Sciences, 2022. 2022. and 7. Hospital HospitalPharmacy PharmacyEurope. Europe. Robots and and automation: automation: aa UK UK perspective. perspective. 8. Enhancing Enhancing operational operational efficiency through through aa robotic robotic efficiency dispensing system: system: aa retail retail dispensing pharmacy case case study. study. pharmacy Pharmacy (MDPI), (MDPI), 2024. Pharmacy 2024. 9. Omnicell calculate OmnicellUK. UK.How Howtoto calculate ROI on pharmacy automation. automation. 2025. 10. Poppintree Poppintree Pharmacy. Pharmacy. Dispensing Automation Automation in in an an Irish Community Pharmacy: an evidence-based evidence-based assessment. assessment. 2026. Full case-study case-study report report available from the author. Disclaimer: Disclaimer:This Thisarticle article is is based based author’s experience experienceatat on the author’s Poppintree Pharmacyfollowing followingthe the Poppintree Pharmacy installation of aarobotic roboticdispensing dispensing installation of system. The The author authorhas hasnot notreceived received for this this article. article.Product Product payment for names are are included includedto todescribe describethe the case study context context only. only.Pharmacy Pharmacy owners should should undertake undertaketheir theirown own assessment of system systemsuitability, suitability, assessment of cost, servicesupport support cost, integration, integration, service and return on on investment. investment. and return

Smarter connectivity. Proven over time. Built for Irish Smarter connectivity. Proven over time. Built for Irish Pharmacies. Pharmacies. Why choose BD Rowa™ EasyLoad?

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BD, the BD Logo and BD Rowa are trademarks of Becton, Dickinson and Company.All other trademarks are the property of their respective owners. © 2026 BD and its BD, thesubsidiaries. BD Logo and Rowa are trademarks AllBD rights reserved. July-2026of Becton, Dickinson and Company.All other trademarks are the property of their respective owners. © 2026 BD and its subsidiaries. All rights reserved. July-2026

Thrombosis

The Risks with Venous Thrombosis As the country heads into the busy holiday season, the Irish Heart Foundation is urging travellers not to overlook a potentially life threatening risk: thrombosis, also known as blood clots. Dr Angie Brown, Consultant Cardiologist and Medical Director of the Irish Heart Foundation

Common signs of DVT include:  Swelling in one leg  Pain, tenderness, or warmth in one calf  Red or discoloured skin

“People often associate clots with aeroplanes, but we see can them after long car trips or ferry journeys as well as long stays in hospital.

 Chest pain particularly on breathing

Preventing thrombosis during travel is largely about keeping blood moving.

 Rapid heartbeat

“People often associate blood clots with serious illness or surgery, but prolonged sitting during travel is a well recognised trigger,” Dr Brown explains.

If you think you may be suffering from either a deep vein thrombosis (DVT) or pulmonary embolus (PE) you need to attend the emergency department. To make a diagnosis some investigations will be performed these may include a blood test for D Dimers, then other tests such as an ultrasound scan of the affected limb usually your leg (or arm). If a PE is suspected then a lung scan, usually a CT Pulmonary angiogram will be performed. Other investigations may include blood gases, a thrombotic screen an ECG and an echocardiogram.

1. Keep Moving

About two-thirds of these cases are DVT, and one-third are PE. It is the third most common cardiovascular disease after myocardial infarction and stroke. Around 4,000 people die of thrombosis related deaths – venous thromboembolism or blood clots in the veins each year. Often associated with long-haul flights and extended car journeys, venous thromboembolism (VTE)—which includes deep vein thrombosis (DVT) and pulmonary embolism (PE)—remains underrecognised despite affecting thousands of people every year. And while most holiday-makers focus on passports and packing, doctors are urging the public not to overlook a less obvious risk: travel related thrombosis, also known as deep vein thrombosis (DVT). In Ireland, thrombosis is a common yet overlooked condition. Around 5,000 people are affected by VTE annually, with more than 1 in 12 people expected to experience a clot during their lifetime.

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Blood clots form when blood flow slows, often during periods of prolonged immobility. Risk increases sharply with age and in certain medical conditions. Risk factors include being over the age of 60, obesity, pregnancy or recent childbirth, use of oestrogen containing contraception or hormone replacement therapy, cancer, previous clots, thrombophilia, recent surgery, or limited mobility. Long distance travel can also increase the risk, particularly when journeys exceed four to six hours, whether by air, car, train or ferry. Despite this, awareness remains low. According to the HSE, 75% of adults have never heard of DVT, and fewer than one in ten can identify its symptoms. Dr Angie Brown, consultant cardiologist and Medical Director of the Irish Heart Foundation, says awareness is crucial. “Thrombosis is often underestimated because it doesn’t always cause symptoms until it becomes serious,” explains Dr Brown. “Yet it’s one of the most preventable causes of death and disability if people understand the risks and take simple precautions.

 Sudden shortness of breath

“It’s immobility — not the destination — that’s the issue.”

“The good news is that many travel related clots are preventable with simple measures.”

Venous thrombosis, including deep vein thrombosis (DVT) and pulmonary embolism (PE), are relatively common conditions, affecting approximately 1 to 2 people per 1,000 annually in Western populations.

Pulmonary embolism symptoms— requiring urgent medical attention—include:

Stand, stretch or walk every 1–2 hours wherever possible. Even simple in-seat exercises—like ankle rotations or calf raises—can help maintain circulation. Also, avoid crossing your legs for long periods. 2. Stay Hydrated Dehydration can thicken the blood, increasing clot risk. Drink water regularly and limit alcohol or caffeine on long journeys. 3. Wear Compression Stockings (If required) For higher-risk individuals, properly fitted compression socks can significantly improve circulation and reduce the likelihood of clot formation. 4. Choose Your Seat Wisely An aisle seat makes it easier to get up and move, which can help lower risk. 5. Know Your Personal Risk “For example if you’ve had a clot before, or you’ve been in hospital and had recent surgery, or have active cancer, it’s essential to speak to your GP before you travel,” advises Dr Brown. In some cases, preventative medication may be recommended. Know the Warning Signs Being able to recognise symptoms early can save lives.

 Coughing up blood

Once a diagnosis has been made the treatment is usually with an anticoagulant (blood thinner), the duration of treatment will depend on the causes and risk factors. If you are pregnant then you may need injections of a blood thinner. In some severe cases stronger thrombolytics may be used or occasionally a thrombectomy using a catheter to suck out the clot may be performed. You may be advised to wear compression stockings. Thrombosis is a leading but preventable cause of illness and death. Many cases—especially those linked to travel—can be avoided with awareness and simple steps. “Travel should be enjoyable, not dangerous,” said Dr Brown. The key message is simple—move often, stay hydrated, and know your risk. These small actions can make a life-saving difference. And if symptoms appear during or after travel, people should seek medical help urgently. Early treatment saves lives.”

Prostate Cancer

Screening for Prostate Cancer Prostate cancer is the most common invasive cancer in men in Ireland and the second leading cause of male cancer death. It represents a major public health challenge and places a substantial financial burden on the healthcare system. According to the Wilson and Jungner principles, a disease is suitable for population screening if it can be detected at an early, curable stage. Prostate cancer fulfils these criteria, as clinically significant disease can often be identified before symptoms develop, allowing curative treatment. Written by Mr David Galvin, Consultant Urologist, Mater and St Vincent’s University Hospitals, and Lead Investigator for PRAISE-U and ProstateCheck.ie in Ireland

recommendations from the European Association of Urology (EAU), but is not part of current practice in Ireland yet, outside of our research study, PRAISE-U.

The introduction of the prostatespecific antigen (PSA) blood test in the 1980s transformed early detection. However, PSA is prostate-specific rather than cancer-specific, and elevated levels may result from prostatitis, benign prostatic hyperplasia (BPH), or prostate cancer. Distinguishing between these conditions is therefore essential to avoid unnecessary investigation while identifying men at greatest risk. In clinical practice, urinary tract infection and prostatitis can usually be excluded through history in the absence of urinary symptoms. Transabdominal ultrasound provides a rapid assessment of prostate volume, allowing calculation of the PSA density by dividing the prostate volume by the serum PSA concentration. A PSA density below 0.15 is associated with a low likelihood of clinically significant prostate cancer. Consequently, a focused history, examination and ultrasound can be completed within 5–10 minutes to assess an individual's risk. Men at low risk can be reassured, and reviewed at appropriate intervals, while those at higher risk can undergo further investigation or specialist referral. This risk-stratified approach forms the basis of current

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In 2021, European countries adopted the EU Beating Cancer Plan, which invested in prevention, early diagnosis and screening for several cancers, including prostate cancer. The EAU-led PRAISE-U consortium secured funding to evaluate implementation of riskstratified prostate cancer screening across Europe. The EAU screening algorithm is based on evidence from the European Randomized Study of Screening for Prostate Cancer (ERSPC), published in 2013. The algorithm recommends followup according to PSA level and individual risk. Five pilot screening programmes were established across Europe, with Ireland leading the development of a digitally enabled home-testing pathway. The Irish pilot centred on homebased PSA testing. Participants completed a finger-prick capillary blood test at home and returned the sample by post for laboratory analysis. Results were interpreted using the EAU algorithm, allowing personalised recommendations regarding future screening or referral to a Rapid Access Prostate Clinic. Ireland's network of eight Rapid Access Prostate Clinics provided the infrastructure for community-based assessment and onward referral. The programme partnered with Enfer Laboratories in Naas, County Kildare, which developed the home testing kit. Participants collected six to seven drops of capillary blood into a collection tube and returned the

sample in a prepaid envelope. Eligible men received invitations through the National Screening Service and enrolled online through the Prostate Check Ireland website, where they completed consent and registration. Testing kits were typically delivered within two to three days, and results were available within a similar timeframe after samples were returned, together with personalised followup advice. For example, a 55-year-old man with a PSA level below 1.0 ng/mL is advised to repeat testing in five years. Men with PSA levels above 3.0 ng/mL are automatically referred to a Rapid Access Prostate Clinic. There, a consultant urologist performs a clinical assessment, physical examination and prostate volume measurement before classifying patients as low or high risk. Men at high risk undergo multiparametric MRI to identify clinically significant disease. The Irish pilot distributed 10,000 invitations across County Waterford, South Dublin and North Dublin, linked to Rapid Access Prostate Clinics at University Hospital Waterford, St Vincent's University Hospital and the Mater Misericordiae University Hospital. A total of 1,680 men enrolled, and more than 90% returned their PSA kit for analysis. Approximately 90% had PSA results within the normal range and did not require referral, providing reassurance while avoiding unnecessary hospital attendance. These men were advised when to repeat testing through their general practitioner. Approximately 125 participants were referred to Rapid Access Prostate Clinics. Seventy-two underwent prostate MRI and, to date, only 19 have required biopsy. Sixteen men were diagnosed with prostate cancer. Some entered active surveillance programmes, while others proceeded to potentially curative treatment. The pilot demonstrated that the EAU risk-stratified screening pathway can be successfully implemented within the Irish healthcare system using a digital, community-based model. Ireland was the first European country to evaluate home-based PSA testing within a

screening programme. Participant acceptance was high, with approximately 90% expressing satisfaction with home testing, while only 10% preferred GPbased blood testing. The risk-stratified pathway also reduced unnecessary investigations. Compared with conventional referral pathways, MRI utilisation fell by approximately 36%, reducing healthcare costs while minimising unnecessary imaging and biopsy in men at low risk of clinically significant disease. Earlier diagnosis through targeted screening also has the potential to reduce the incidence of advanced prostate cancer, which is associated with poorer outcomes and substantially greater treatment costs. The success of the Irish pilot has generated considerable interest internationally. Research groups in the Netherlands and Germany are evaluating similar home-testing strategies, while Germany is also investigating pharmacy-based screening programmes in which pharmacists perform capillary finger-prick PSA testing. Such initiatives could improve accessibility and increase participation in organised screening programmes. In Ireland, the National Screening Advisory Committee will ultimately determine whether a national prostate cancer screening programme should be introduced. Across Europe, however, risk-stratified prostate cancer screening is gaining momentum. Lithuania has become the first European country to recommend national implementation of the European Union risk-stratification algorithm. A decision by the European Commission, expected in 2027, is anticipated to provide further direction on the future implementation of organised screening programmes for prostate, lung and gastric cancer across Europe. If you have any questions don't hesitate to contact me at david.galvin@ucd.ie Website: https://prostatecheck.ie OR https://uroweb.org/praise-u

Topic Team Training – Stress A community pharmacy environment that fosters teamwork ensured high levels of consumer satisfaction. This series of articles is designed for you to use as guide to assist your team in focusing on meeting ongoing CPD targets and to identify any training needs in order to keep the knowledge and skills of you and your team up to date. The below information, considerations and checklist provides support to enable you to run a team training session and identify opportunities for learning within the topic of Stress. Stress is one of the most common conditions in Ireland. Recent research shows that Ireland ranks among Europe’s ‘most stressful’ countries. Pharmacy customers often choose to self-treat stress using over-the-counter (OTC) products and are likely to rely on the advice of the pharmacist and pharmacy teams. Going back to school can trigger feelings of worry and anxiety in some children. In the pharmacy you may meet several parents of children who are concerned about their children experiencing stress during this period. Understanding the causes of common worries can help you to support parents and children during this time. Some of the more common concerns are discussed here. While a small amount of stress around exams is common, if the levels of stress are affecting sleep and daily tasks it is time to encourage parents to take action. Schools can offer support to students who are worried about exams. If additional help is needed the GP is the first port of call for children who are experiencing high levels of anxiety. In a small number of cases children can be diagnosed with anxiety disorders requiring medical intervention or counselling. Pharmacists can play a crucial role in managing exam stress by providing various services and advice to students and individuals experiencing stress and anxiety during exam periods. Their role extends beyond just dispensing medications to offering comprehensive support that can contribute to overall well-being. Here’s how pharmacists can help manage exam stress: Education and Awareness • Understanding Stress and Anxiety: Pharmacists can educate students about the physiological and psychological aspects of stress and anxiety,

helping them understand their symptoms better. • Identifying Symptoms: They can assist in identifying symptoms of stress and anxiety, such as insomnia, fatigue, irritability, and difficulty concentrating, and differentiate between normal stress and more severe anxiety disorders. Lifestyle and Behavioural Advice • Sleep Hygiene: Provide tips on improving sleep hygiene, such as maintaining a regular sleep schedule, creating a restful environment, and avoiding stimulants before bed. • Nutrition and Hydration: Advise on a balanced diet rich in fruits, vegetables, whole grains, and adequate hydration, emphasising the importance of maintaining energy levels and concentration. • Exercise: Recommend regular physical activity as a means to reduce stress and improve mood, suggesting activities like yoga, walking, or sports that students can easily integrate into their schedules. • Relaxation Techniques: Teach relaxation techniques such as deep breathing exercises, mindfulness, and meditation, which can help manage stress levels. Pharmacological Support • Over-the-Counter Products: Suggest over-the-counter products that can help with mild symptoms of stress and anxiety • Sleep Aids: Recommend appropriate non-prescription sleep aids if insomnia is an issue, while advising on the importance of not becoming reliant on these for long-term use • Medication Management: For students already on prescription medications for anxiety or depression, pharmacists can ensure proper medication adherence and manage any potential side effects or interactions

Consider:  The signs and symptoms of stress amongst younger people  How to identify those who need to be referred to further mental health support  The benefits of appropriate nutrition and lifestyle factors  Appropriate treatment and advice

Counselling and Support • Emotional Support: Provide a listening ear and emotional support to students who may feel overwhelmed, creating a safe space for them to express their concerns. • Referral to Mental Health Services: Recognise when a student may need more specialised mental health support and refer them to counsellors, psychologists, or psychiatrists as appropriate. Individualised Care • Personalised Advice: Tailor advice to the individual's specific situation, taking into account their lifestyle, academic pressures, and personal stressors. Key Points: Check your pharmacy team are aware and understand the following key points:  The pharmacy team knows to understand the importance of maintaining good mental health  The team are able to initiative conversations with parents and care-givers  The team are aware of the OTC treatments available  My pharmacy assistants can meet the points in this training checklist.

• Follow-Up Care: Provide follow-up consultations to assess progress and make any necessary adjustments to their stress management plan. Pharmacists are well-positioned to contribute significantly to the management of exam stress by combining their expertise in medication with a holistic approach to health and wellbeing. By offering education, support, and personalised care, pharmacists and their teams can help students develop effective coping strategies, improve their academic performance, and enhance their overall quality of life.

Actions:  Ensure the team can meet the needs of younger patients who are experiencing stress  Ensure that I and the team are aware of the treatments and appropriate counselling  Do we understand the reasons why some people may be at greater risk of stress? What are these?  Are we able to provide confidential and discreet consultation rooms?  Can we provide good advice on the different types of OTC treatments and their suitability for each patient  Train the team to meet all the above considerations

IRISHPHARMACYNEWS.IE | 93

News

Irish Patients Hiding Treatments One in three (32%) weight-management patients in Ireland admit to hiding their treatments from family and friends, with a quarter (25%) lying about how they have lost weight.

¤150m Investment Another significant step in the ongoing development of health services in the northeast of the country, with major developments announced across hospital and community care. Taken together, the announcements represent an investment of over ¤150 million in expanding capacity, modernising facilities and improving access to care for the region’s growing population. Together with other recent projects, they form part of a wider programme of investment to strengthen services across the Dublin and North East region.

That’s according to new research commissioned by Lloyds Online Doctor, which sheds light on the extent to which stigma and shame are shaping patient behaviour around this new generation of medication. Three in four (77%) people, who are using, considering or previously used weight-management treatments, believe there is a greater stigma attached to them compared with traditional methods such as diet and exercise. To conceal their use of treatments, one in four (23%) weightmanagement patients in Ireland have said they avoid collecting medication from local pharmacies, while 19% have arranged for it to be delivered to a different address. The findings reflect a broader issue for people living with obesity in Ireland. Obesity-related stigma remains deeply entrenched, with patients waiting on average eight years from first being concerned about their weight to discussing it with a healthcare professional1. Furthermore, 70% of people living with obesity report stigma when engaging with healthcare services in Ireland. Dr Kieran Seyan, Chief Medical Officer at Lloyds Online Doctor, says: “These findings suggest that many people who use, or are considering using, weightmanagement medication still feel concerned about how others may perceive their treatment decisions.

IRISHPHARMACYNEWS.IE

“Obesity is a chronic health condition, and for some patients, clinically prescribed medicines can form an important part of evidencebased weight management alongside lifestyle changes. “In my clinical experience, some patients feel uncomfortable discussing their use of weightmanagement medication with friends, family or colleagues, despite being open about treatments they take for other long-term health conditions. When people feel judged for seeking help, it can create unnecessary barriers to accessing care. “Ireland faces a significant challenge from obesity and its related health consequences. If we want to improve health outcomes, it is important that people feel able to access appropriate medical support without fear of embarrassment or judgement. These findings suggest there is still work to do to normalise evidencebased obesity management and encourage more people to seek help when they need it.” Issues with access The research also suggests that social perceptions are only one part of the challenge, with respondents identifying affordability and availability as important barriers to treatment access. Cost is one of the biggest obstacles preventing people from accessing treatment. Four in

five (78%) patients said financial pressures have impacted how they use, or have used, their weight-management medication. A further one in three (31%) respondents considering treatment say affordability is the reason they haven’t sought help. The findings also highlight the lengths some patients are willing to go for treatment. One in four (27%) who source their medication from unlicensed providers do so due to cost, while one in five (20%) said limited availability of weightmanagement medicines through Irish state-funded schemes had led them to do so. Some are looking beyond the Republic altogether, with one in four (25%) travelling to Northern Ireland for a prescription. Lloyds Online Doctor has recently expanded its weight-management service in Ireland, allowing eligible patients to have their prescribed treatment delivered to their door. Patients who undergo a clinical weight-management consultation via the Lloyds Online Doctor website from Monday to Saturday and are prescribed treatment, where clinically appropriate, can choose to have their prescription fulfilled and delivered by a pharmacy delivery partner or collect it from a pharmacy of their choice. Through the new service eligible patients placing an order for their prescription before 12pm on a weekday can expect delivery within 24-48 hours.

At Cavan General Hospital, the Minister for Health officially turned the sod on a major extension representing an investment of over ¤100 million. The development will deliver a new Emergency Department, an expanded Endoscopy Unit and 56 additional inpatient beds, significantly strengthening hospital capacity and supporting safer, more timely care for people across Cavan, Monaghan and the wider North East. In Navan, the development of a major new Primary Care Centre will now commence. The sevenstorey facility will bring a broad range of health and community services together in one modern, accessible location, replacing several dispersed sites and supporting more integrated care, while enabling people to access services closer to home. The Minister also officially opened the new 18-bed Willowbridge Ward dementiafriendly ward and took in the new Rehabilitation, Dementia and Remembrance Garden at Monaghan Hospital. These developments provide a more therapeutic, accessible and dementia-inclusive environment, supporting the dignity, independence and wellbeing of patients, and reflecting the region’s focus on improving care for older people. The announcements reflect the HSE’s regional approach to planning and delivering services for a growing and changing population in Dublin and North East. They also support Sláintecare by strengthening hospital capacity and expanding primary and community services so that people can receive the right care, in the right place, as close to home as possible.

Health App

The HSE Health App: Empowering Patients Through Digital Health Digital health is becoming an increasingly important part of healthcare delivery in Ireland, and the HSE Health App serves as a key access point to Ireland’s health services. It empowers patients and citizens to easily navigate care, access their health records, receive important communications, and manage their health and wellbeing, both proactively and when care is needed. The HSE Health App, which has been downloaded over 400,000 times, is a tool designed to give patients easier access to their health information and to trusted services provided by the HSE. For healthcare staff, the app offers an opportunity to support patient education, selfmanagement, and engagement with healthcare services. Who can use the HSE Health App? The app is free to download on the App Store and Google Play Store to anybody over the age of 16. Users can access their personal health information by logging into the app using a verified MyGovID. HSE Health App features are also available on the HSE website. Users can log in and access their HSE Account using their verified MyGovID. Sections of the app can be used without logging in to access HSE information and find care services such as GPs, hospitals and primary care centres.

What can the HSE Health App be used for?

Written by Shane McGannon, Digital App Manager, HSE

By logging into the app, users can see some appointments with information about them. The app will notify patients about new appointments and changes to appointments. Users can also see waiting lists they are on, and any GP referrals made on their behalf.

support and a physical activity programme, Get Active.

Digital versions of health cards, such as Medical Cards and GP Visit Cards, are available to applicable users alongside COVID-19 and flu vaccine records, and reimbursed medicines.

Not all hospital appointments and waiting lists are in the app. 36 public hospitals, 23 community services and two surgical hubs have their appointment information integrated in the app. For a full list, visit the HSE website.

A record of a patient’s hospital procedures (coded for the Hospital Inpatient Enquiry system), hospital discharge summaries and some GP-ordered blood test results available in the HSE Shared Care Record are displayed to users. Not all procedures, discharge summaries and test results will be shown but more will be added in future releases. The app also offers care support plans including the HSE Quit Plan to stop smoking, maternity care

What should healthcare professionals be aware of?

The app allows users to input a list of medicines, allergies, emergency contact details and GP details that are shared with the HSE Shared Care Record to support clinical care and delivery as this information will provide healthcare practitioners with a more holistic profile of patients. Encouraging patients to maintain up-to-date information can support safety, particularly for those with complex treatment regimens or multiple prescriptions. As part of a gradual introduction of laboratory blood test results, Hemoglobin A1c and lipid profile tests are the first GP-ordered results to be displayed in the HSE Health App. Results are displayed in the app 14 days after the GP has received the results to allow the GP to contact the patient. Increasing awareness

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Healthcare professionals can play a role in increasing patient awareness and adoption of digital health tools and are well placed to introduce patients to the app during routine interactions such as appointments and health promotion consultations. A brief conversation about the benefits of the app and how to download it can empower patients to take a more active role in managing their health. As digital healthcare continues to evolve, tools like the HSE Health App have the potential to enhance communication, improve access to information, and support patient self-management. By promoting awareness and guiding patients in its use, healthcare professionals

can play an important role in helping patients benefit from these new digital health services. As of July, HSE Health App features have been made available through the HSE website. This web version of the app has been introduced to increase accessibility to the benefits of the app. Users can register or log in to their HSE Account using the same MyGovID login that they use for the app. For posters or assets that can be used for social media promotion, contact digital@hse.ie. What’s coming next on the app? The app will soon have more information from the HSE Shared Care Record displayed to users which will provide patients with more information about their personal health records. Information such as prescribed medicines and conditions will be amongst the next data points that will flow into the app from this source. Work is ongoing to add to the list of hospitals that are integrated with the app. Telemedicine appointments have already added to the app for hospitals already in the app. Community Care appointments, including home visits, will be introduced to the app over the coming months. Future app features will be guided by ongoing research and engagement with patients, HSE staff, and the public. To see a full list of features in the HSE Health App, visit the HSE website.

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Clinical Profiles

IRISH SCIENTIST SIR ADRIAN HILL WINS EUROPEAN INVENTOR AWARD 2026 FOR HIGHLY EFFECTIVE MALARIA VACCINE

MINISTER NORMA FOLEY OFFICIALLY OPENS ALLIANCE MEDICAL'S NEW INDEPENDENT ¤4.5 MILLION IMAGING CENTRE IN TRALEE

The European Patent Office (EPO) has awarded Irish scientist Sir Adrian Hill the European Inventor Award 2026 in the Research category for developing the R21/Matrix-M malaria vaccine. According to the World Health Organization (WHO), there were an estimated 282 million malaria cases and 610 000 malaria deaths worldwide in 2024, with children under five accounting for about 75% of malaria deaths in the WHO African Region.

Alliance Medical is marking over 20 years of providing diagnostic healthcare services in the Kerry region with the official opening today of a new ¤4.5 million independent, outpatient imaging centre at Manor West, Tralee.

Traditional malaria vaccines achieved only modest protection, particularly in young children. Hill and his team developed a vaccine that presents more of the malariaspecific protein regions needed to trigger a strong immune response, helping to achieve around 75–80% protection in clinical trials. The European Inventor Award recognises inventors whose innovations provide answers to some of the world’s most pressing challenges. The other finalists in the Research category were Portuguese researcher Paula Videira and team for a high-precision antibody that distinguishes cancer cells from healthy tissue and Finnish physicist Mikko Möttönen for an ultrasensitive cryogenic microwave sensor to improve quantum computing hardware. “I am delighted to accept this prestigious award on behalf of the many hundreds of people who have contributed to the discovery, development and licensure of our malaria vaccine over the past 12 years,” said Sir Hill. Improving protection against malaria Scientists have been attempting to develop a malaria vaccine for more than a century, yet more than 150 vaccine candidates entered human trials before two finally succeeded. Earlier vaccines, including RTS,S, typically achieved only modest efficacy in young children. Hill's team redesigned the vaccine structure to include more of the key malaria protein segments recognised by the immune system, while removing components that could divert the immune response. The vaccine forms nanoparticles approximately 25 nanometres in size, helping the immune system recognise and respond more effectively. Combined with the Matrix-M adjuvant, the vaccine generates a substantially stronger antibody response than earlier approaches.

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Sir Adrian Hill

The vaccine was also designed for practical deployment. It can be produced at large scale, costs less than EUR 3 per dose and remains stable for up to two years under standard refrigeration conditions, helping make vaccination programmes more accessible in regions where malaria remains endemic. Building a vaccine for largescale deployment Hill's long-term commitment to malaria research was shaped by his 1988 experience in The Gambia, where he witnessed the devastating impact of the disease on young children. Over the following three decades, his team at Oxford's Jenner Institute investigated multiple vaccine candidates before developing R21/Matrix-M. The project brought together partners including the University of Oxford, the Serum Institute of India, Novavax and leading African research centres in Burkina Faso, Kenya, Mali and Tanzania. A key milestone came in 2021, when Phase 2b trial results showed up to 77% efficacy, exceeding the WHO target of 75% for malaria vaccines. Ghana became the first country to approve the vaccine in 2023, followed by Nigeria. Later that year, the WHO formally recommended R21/Matrix-M for widespread use. Today, malaria vaccination is being integrated into routine immunisation programmes in more than 20 African countries, providing a new tool to reduce malaria-related illness and deaths.

Officially opened by Norma Foley, Minister for Children, Disability and Equality, the new Manor West Imaging Centre represents a major expansion of community diagnostic services in the region, providing patients with faster access to high-quality imaging closer to home. The investment reinforces Alliance Medicals long-standing commitment to delivering accessible, patient-centred healthcare within local communities. The centre is staffed by experienced radiographers and a dedicated customer-focused administration team, delivering high-quality diagnostic care in a modern outpatient setting. A key strength of Alliance Medical’s service is that all scans are reported by local, Ireland-based, RCSI-accredited consultant radiologists, ensuring expert clinical reporting, continuity of care and close collaboration with referring clinicians. Together, this experienced multidisciplinary team delivers the highest standards of diagnostic quality for patients across Kerry. As a county with a proud sporting tradition, Kerry has long relied on expert injury assessment and diagnosis to keep athletes performing at their best. Alliance Medical supports athletes at every level through specialist musculoskeletal (MSK) imaging, delivered by its team of experienced RCSI-accredited Consultant Musculoskeletal Radiologists, including Dr Jennifer Ní Mhuircheartaigh whose family hail from Kerry. As the Exclusive Imaging Partner of Kerry GAA for 2026, Alliance Medical is proud to support the health and wellbeing of Kerry's sporting community, from grassroots to county, particularly as Kerry prepares for the All-Ireland Senior Football Championship Final. Speaking at the official opening, Norma Foley, Minister for Children, Disability and Equality, said, ‘I am delighted to officially open Alliance Medical’s new imaging centre in Tralee. This significant investment represents an important enhancement of healthcare services for the people of Tralee and Kerry, providing greater access

to high quality diagnostic imaging in a modern, patient-centres environment. Facilities like this support earlier diagnosis, better outcomes and stronger healthcare delivery in our communities and I welcome this significant investment by Alliance Medical.’ Eimear O'Donnell, Human Resources Director at Alliance Medical, added, ‘For more than 20 years, Alliance Medical has been proud to be part of the healthcare landscape in Kerry, providing high-quality diagnostic imaging services to local patients and supporting the clinicians who care for them. The opening of our new Manor West Imaging Centre marks an important new chapter in that journey. This is much more than a new building for us. It's an investment in the future of healthcare in Kerry and reinforces our long-standing commitment to the people and communities we proudly serve. By continuing to invest in high-quality diagnostic imaging, we’re helping patients get the answers they need sooner and supporting better health outcomes across the region.’ Doireann Ní Shéaghdha, Area Manager, Alliance Medical Diagnostic Imaging, said, ‘Opening the doors of our new Manor West Imaging Centre is a proud moment for our team. As Alliance Medical enters its third decade of caring for the people of Kerry, we’re delighted to welcome patients to a modern outpatient diagnostic imaging centre designed around their needs. Every aspect of the clinic has been designed to provide a welcoming, comfortable and efficient experience, strengthening access to community-based diagnostics. With MRI, CT, X-ray, Ultrasound and DEXA available under one roof, supported by an experienced team and timely reporting by Irish based consultant radiologists, we’re committed to providing the standard of care we’d want for our own families. We’re proud to continue enhancing healthcare provision for the people of Kerry for many years to come.’ The Manor West Imaging Centre brings MRI, CT, X-ray, Ultrasound and DEXA services together under one roof in a modern outpatient setting. The centre joins Alliance Medical’s network of more than 40 clinical locations across Ireland, continuing the organisation’s longstanding investment in communitybased diagnostic imaging. BOOTS AND THE IRISH CANCER SOCIETY LAUNCH ANNUAL ‘NIGHT WALK FOR NIGHT NURSES’ Boots has officially launched its annual Boots Night Walk for the Irish Cancer Society Night Nurses,

97 close to a parent, and families can spend meaningful time together in the place that matters most, home. “This vital service would not be possible without the longstanding support of Boots Ireland, its colleagues, customers, and everyone who supports the Boots Night Walk. “Your generosity helps families across Ireland receive compassionate care where they most want to be, at home. We are sincerely grateful for your support and the difference it makes every day." Members of the public can support the campaign in three simple ways:

• Register for the 3.5km Walk: Sign up at www. bootsnightwalk.com for a ¤15 entry fee (children under 16 walk for free). Every adult participant receives an official event T-shirt and an automatic personal iDonate fundraising page to help rally support from friends and family. • Buy an Honour Tag: Purchase an Honour Tag for ¤3 at any Boots nationwide to write a personalised dedication to a loved one affected by cancer. • Make a donation online at www.bootsnightwalk.com

calling on people across the country to sign up and step out for a 3.5km walk on Tuesday, 8th September 2026. Participants can choose to join the main event in Dublin’s Phoenix Park or complete a walk in their local communities, all to raise vital funds for families navigating end-of-life care for loved ones at home.

“When our Night Nurse, Anne, came through the doors during our mam’s final days, it was like an angel walked in. She provided much-needed respite and relief for our family when we needed it most. We are so grateful to this service, and for those who support the care that Night Nurses provide to families all around Ireland.

The Irish Cancer Society Night Nursing service provides free, compassionate end-of-life care to cancer patients in their own homes, allowing them to spend their final days surrounded by loved ones. Since establishing its landmark partnership with the charity in 2012, Boots has raised more than ¤4.5 million, a milestone that has funded over 11,400 nights of free home care for families in need. The demand for Night Nursing remains critical as every year in Ireland, almost 9,800 people die from cancer or cancerrelated illnesses.

“I hope as many people as possible come to the Boots Night Walk on September 8th. We’ll be bringing buses full of supporters to Phoenix Park and hope to see you there.”

Una Leonard, Author and Baker, said: “You don’t realise how important this service is until you need it for your own family. My mam was diagnosed with breast cancer nine years ago, and my family and I cared for her during this time.

Nikki Gallagher, CEO, Irish Cancer Society, said: "Most people with cancer want to spend their final nights at home, surrounded by loved ones. More families can have that precious time together, thanks to the Irish Cancer Society's Night Nursing Service. “Our Night Nurses provide expert overnight care and comfort, allowing patients to remain at home while giving family members the reassurance and rest they need. Behind every night of care is a family supported through one of life's most difficult moments. It means a spouse can sit beside their loved one, children can be

Martha Ryan, People and ESG Director at Boots Ireland said: “We are incredibly proud of our colleagues and of the difference this partnership continues to make for families and communities across Ireland. The Boots Night Walk is a powerful opportunity for people to come together, to honour, support and remember loved ones and help ensure the Irish Cancer Society’s Night Nursing Service can continue providing vital care when families need it most. We are encouraging colleagues, customers and communities across the country to sign up, step out and support this year’s walk.” To learn more, register for the walk, or make a donation, visit www. bootsnightwalk.com NEW CONTINUOUS GLUCOSE MONITOR WHICH PREDICTS OVERNIGHT HYPOGLYCAEMIA NAMED ON HSE PREFERRED SENSOR LIST A IN REPUBLIC OF IRELAND A new continuous glucose monitor (CGM) that can predict overnight hypoglycaemia for adults with diabetes has been named on the HSE preferred sensor list A for HCPs in the Republic of Ireland. The device is available to people with type 1 diabetes who do not use insulin pumps.

Roche Diagnostics’ Accu-Chek SmartGuide is designed to help adults with diabetes predict dangerous blood glucose levels, forecasting glucose levels up to 30 minutes and two hours ahead, as well as overnight for up to seven hours. A water-resistant sensor worn on the back of the upper arm sends readings to a smartphone app every five minutes, helping people stay informed and take action before hypoglycaemia or hyperglycaemia occurs. The addition of Accu-Chek SmartGuide CGM to the HSE preferred sensors list signifies that the device has been deemed among the best value options for both HCPs and patients. Dr Tomás Griffin, Consultant in Diabetes, Endocrinology and General Internal Medicine at Galway University Hospitals, said: "It is encouraging to see continued innovation and greater choice in continuous glucose monitoring for people living with diabetes. Diabetes management requires daily attention, and CGM can reduce some of that burden by providing timely information on glucose levels, trends, and, in some systems, predictions of where glucose levels may be headed. “No single device will suit everyone. People differ in their clinical needs, lifestyles, preferences, digital confidence and the features they value most. Having access to a wider range of CGM options allows people, together with their healthcare professionals, to choose the system that best meets their individual needs. Greater choice can support more personalised diabetes care, improve confidence in day-to-day decision-making and help people manage their glucose levels while maintaining their quality of life." Accu-Chek SmartGuide was made available under reimbursement for people living with type 1 diabetes in the Republic of Ireland in February this year. It is estimated that around 300,000 people in the Republic of Ireland are living with diabetes, and while continuous glucose monitoring has transformed care in recent years, many still struggle to keep their blood sugar within a healthy range. Low blood sugar episodes, known as hypoglycaemia, are particularly common in people with type 1 diabetes and can be especially dangerous during sleep, when warning signs may go unnoticed. Research suggests that between 2–5% of deaths in people under 40 with type 1 diabetes are linked to nighttime hypoglycaemia, making early detection and prevention critical.

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Clinical Profiles IRELAND RECOGNISED FOR INNOVATIVE CARDIAC REHABILITATION EFFORTS IN NEW WORLD HEART FEDERATION GLOBAL ROADMAP

Peter Hampson, Head of Medical Affairs at Roche Diagnostics UK & Ireland, said: “For many people living with diabetes, the fear of blood sugar dropping overnight is a constant worry. This technology helps remove some of that uncertainty by predicting potential lows before they happen, giving people greater confidence and peace of mind in their dayto-day lives. Roche Diagnostics is incredibly proud to be helping people feel safer and more in control of their diabetes." The news follows Roche Diagnostics’ integration of the Accu-Chek SmartGuide and Accu-Chek SmartGuide Predict apps into the mySugr app, which now has more than seven million registered accounts worldwide. The integration brings users’ glucose data, predictive insights and diabetes management tools together in one platform, making it easier to access and manage this information in one place. PEOPLE AFFECTED BY PROSTATE CANCER AND THEIR PARTNERS LEFT ‘SUFFERING IN SILENCE’, NEW STUDY FINDS An Irish Cancer Society-funded research study has revealed that many prostate cancer patients and their partners were unprepared for the impact of treatment on their sexual function. The ground-breaking PROACT (Patient-led Research On sexual experience After Cancer Treatment) Survey aims to understand how prostate cancer treatment affects intimacy, mental health, and quality of life for both patients and their partners. Around 4,000 men are diagnosed with prostate cancer in the Republic of Ireland each year, and about 1 in 7 men will be diagnosed with prostate cancer in their lifetime. The PRO-ACT study, which is now closed*, found that 40% of prostate cancer patients felt they were under-prepared for the impact of treatment on their sexual function, while 66% said they were either underprepared or completely unprepared. A longer or clearer discussion with their medical team or doctor would’ve helped them to be more prepared for the impact of treatment on their sexual function, according to 80% of prostate cancer patients who filled in the survey. 60% said the impact of treatment on their sexual function was either worse or much worse than they expected. The survey for partners of prostate cancer patients found that only 65% said they were present at the

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Ireland’s commitment to cardiac rehabilitation has been recognised by the World Heart Federation (WHF). The country has been selected as one of only five countries worldwide (and the only one from Europe) to feature as a case study in the upcoming WHF Roadmap on Cardiac Rehabilitation. The recognition reflects Ireland’s innovative and integrated approach to delivering cardiac rehabilitation services and its commitment to improving outcomes for people living with cardiovascular disease. L-r: Claire Hopkins (Head of Marketing at Cancer Trials Ireland), Martin Sweeney (Co-chief investigator of PRO-ACT and prostate cancer patient), Dr Claire Kilty (Head of Research at the Irish Cancer Society) and Niki Warner (Programme Manager - Research Partnerships at the Irish Cancer Society) appointment where their partner’s sexual function was discussed. 78% said their own sexual wellbeing wasn’t mentioned or discussed with them at all. The survey was led by co-chief investigators Martin Sweeney, who was diagnosed with prostate cancer in 2015 and is a member of Cancer Trials Ireland’s patient consultants committee, and Professor Paul Kelly, a radiation oncologist, under the guidance of Cancer Trials Ireland. PRO-ACT Co-Chief Investigator and prostate cancer patient Martin Sweeney said:“The results of PRO-ACT show there is a deficit of information at the critical stages of diagnosis and posttreatment for prostate cancer patients and their partners. “There are services that are not provided at all, like physical therapy, sexual therapy, and mental health. Existing medical teams try their best but typically aren’t qualified in these areas, and it’s unrealistic to expect clinicians to be able to address all of these needs. “PRO-ACT shows that there is a significant gap in the patient pathway, leaving many patients and their partners to suffer in silence. We need wraparound services to support people affected by prostate cancer. “We know that people are now living longer after a prostate cancer diagnosis, and survival rates are improving. In my own family history, I’ve seen how survival rates have changed. My grandfather died as a result of prostate cancer, and my father had prostate cancer 40 years ago.

“The survival side of low-grade, localised prostate cancer is thankfully well managed, so now we need to look at quality-of-life for people living well after prostate cancer. The results of PRO-ACT decisively show the unmet needs of prostate cancer survivors and their partners, and the pressing need for them to be addressed. "A change of mindset is needed in prostate cancer care, and there is a need for a greater focus on peer and specialist support. It is essential that the patient's intimate partner is a part of all of this. "We need to ensure that patients and their partners can live their life to fullest after a prostate cancer diagnosis.” Dr Claire Kilty, Head of Research at the Irish Cancer Society, said: “We at the Irish Cancer Society are proud to fund pioneering patient-led research like PRO-ACT, and we’re grateful to everyone who took part and shared their experiences so openly. “The results of the PRO-ACT study provide greater insight into the lived experience of people with prostate cancer and their partners. “The patient voice is at the centre of the results, and the input from people affected by prostate cancer and their partners has brought into focus the need for more robust services to help people to live well after a prostate cancer diagnosis.”

WHF Roadmaps provide evidencebased solutions to address challenges in the prevention, detection and management of cardiovascular disease and serve as an important resource for policymakers and health agencies worldwide. The forthcoming roadmap is the first to focus specifically on cardiac rehabilitation, making Ireland’s inclusion a notable achievement on the international stage. This is the first roadmap developed that has focussed on cardiac rehabilitation. Ireland’s case study, entitled “Leveraging Policy to Deliver Cardiovascular Health Programmes in an Integrated Way,” highlights the country’s commitment to cardiac rehabilitation as a critical component of the National Framework for the Prevention and Management of Chronic Disease. The framework promotes a whole-system approach to chronic disease management, encompassing health promotion, disease prevention, diagnosis, treatment and rehabilitation. Key achievements highlighted in the case study include: • Investment in Chronic Disease Hubs, with one hub serving every 150,000 people, ensuring local and accessible care, including cardiac rehabilitation services. • Development of the National Model of Care for Integrated Cardiac Rehabilitation in 2023, which promotes a personalised approach and provides patients with greater choice regarding how, where and when they participate in rehabilitation programmes. • Completion of a National Cardiac Rehabilitation Needs Analysis in 2024, which identified the need to

99 “The National Health Office is committed to supporting the delivery of the end-to-end integrated Model of Care for Cardiac Rehabilitation for the eligible population and advocating for the resources required to address existing gaps in service provision. Achievements such as this highlight the excellence, innovation and dedication of our healthcare professionals and reinforce the importance of continued investment in cardiac rehabilitation services for patients nationwide.”

Pictured at the Cardiac Rehabilitation Programme, Knocknacarra Community Centre, Galway, from left, Naomi Flynn, Assistant Staff Officer Integrated Care Programme; Sarah Lee, Staff Nurse Cardiology; Gerard Carr; Danielle Derivan, Cardiac Rehabilitation Co-Ordinator; Thomas Samuel, Senior Physiotherapist Cardiac Rehabilitation; Catherine Uí Chadhain; Ciara Casey, Clinical Specialist Dietitian in Cardio-Metabolic Chronic Disease; Padraic Lydon and Martin Seary. Front from left, Teresa Higgins, Interim Operational Lead Integrated Care Chronic Disease Programme and Anne Gibbons

standardise programme delivery and increase staffing levels nationwide. • A commitment through the National Service Plan 2025 of more than ¤1 million in staffing investment to support the implementation of a demonstration project of the Cardiac Rehabilitation Model of Care in HSE West and North West. • Development of the HSE Cardiac Rehabilitation Clinical Action Guide in 2025, providing practical support and guidance for teams implementing the Model of Care. As a result of the injection of funding, patients in Galway, Mayo and Roscommon are now benefitting directly and for the first time have access to a full clinical team that includes nurses, dietitians, physiotherapy and psychology. Gerard Carr from Moycullen, who recently completed the 12-week Cardiac Rehabilitation Programme, praised the support and education provided throughout his recovery. “The programme was excellent, well organised, well-structured and delivered by a brilliant team. After my heart attack in January, I thought I already had a good diet and exercise routine, but the education aspect of the programme taught me so much that I simply didn't know before. “What really stood out was the support from both the staff and the other participants. Being alongside people who had gone through

similar experiences meant you never felt alone in your recovery. Completing the programme has given me greater confidence, knowledge and motivation." Dr Susan Connolly, Consultant Cardiologist at Galway University Hospitals and Galway City Integrated Care Hub and who is the lead for the national demonstration project in CR said, “Ireland’s inclusion in the World Heart Federation Roadmap on Cardiac Rehabilitation as one of only five international case studies is a significant endorsement of the progress being made in cardiac rehabilitation nationally. It reflects the commitment of patients, clinicians, managers and policymakers working together to strengthen cardiac rehabilitation services and deliver an integrated, person-centred Model of Care. It is great to see this incredible international recognition. Ireland is leading the way in the delivery of cardiac rehabilitation and this demonstrates that investment in cardiac rehabilitation is delivering real benefits for patients.” Prof Ken McDonald, Clinical Co-Lead, National Heart Office said: “Sincere congratulations to Dr Connolly and the team on their outstanding achievement in representing Ireland on the world stage and for their ongoing commitment to raising the standards of care for cardiac patients across the country. Cardiac rehabilitation is proven to significantly reduce illness, hospital admissions, mortality and to improve quality of life for participants.

Minister for Health, Jennifer Carroll MacNeill TD, said: "This recognition from the World Heart Federation is a testament to our shared commitment to ensuring that people living with cardiovascular disease receive the support they need, not only during treatment but throughout their recovery journey. "It reflects the strong progress we have made in building integrated cardiovascular services, from expanding access through Chronic Disease Hubs to introducing a new National model of Care that gives patients greater choice in how and where they receive rehabilitation.” MATER PRIVATE NETWORK FIRST IN EUROPE TO JOIN FARADIGM TRIAL OF NEXTGENERATION AF ABLATION TECHNOLOGY Mater Private Network has announced its participation in the FARADIGM clinical trial, a global study evaluating the safety and effectiveness of Boston Scientific's FaraFlex™ Mapping and Pulsed Field Ablation Catheter for the treatment of patients with paroxysmal and persistent atrial fibrillation (AF). Mater Private Network is among the first centres worldwide to participate in the study, and the first in Europe to use the integrated mapping and pulsed field ablation technology. The FARADIGM trial combines high-density cardiac mapping with pulsed field ablation, enabling physicians to map the heart's electrical activity in greater detail before delivering targeted therapy. By integrating mapping and treatment into a single platform, the technology has the potential to support more personalised treatment planning and greater procedural precision for patients with complex cardiac arrhythmias. Irish involvement in the global trial will be led by Prof. Gábor Széplaki, Head of Cardiac Electrophysiology at Mater Private Network in Dublin, who is a member of the study steering committee.

Atrial fibrillation is the most common sustained cardiac arrhythmia, affecting an estimated 12.9 million people across Europe. Left untreated, it significantly increases the risk of stroke, heart failure and other cardiovascular complications, making continued innovation in treatment an important priority for clinicians and healthcare systems alike. Commenting on the trial, Prof. Gábor Széplaki said: “Mater Private Network has a longstanding commitment to advancing the treatment of cardiac arrhythmias through clinical research and innovation. Being among the first centres globally to participate in the FARADIGM trial, and the first in Europe to use this technology, reflects our commitment to ensuring patients have access to the latest developments in electrophysiology. “Atrial fibrillation affects millions of people worldwide and can substantially raise the risk of stroke and heart failure if left untreated. Integrating detailed cardiac mapping with pulsed field ablation will allow us to map the heart's electrical activity in greater detail, creating the potential to deliver a more precise, targeted, and ultimately more effective treatment to our patients. As a hospital, we pride ourselves in being a leader in cardiovascular medicine and research, and we are proud to contribute to the international evidence base evaluating this promising technology.” Should the FARADIGM trial demonstrate favourable safety and effectiveness outcomes, the technology could help expand treatment options for patients with both paroxysmal and persistent AF, while supporting more precise and individualised ablation procedures. The study represents an important step in the continued evolution of pulsed field ablation, an emerging technology that has transformed the field of cardiac electrophysiology in recent years. Mater Private Network's participation further strengthens its role within an international network of leading centres helping to evaluate next-generation cardiovascular technologies and shape future standards of care for patients with atrial fibrillation. As Ireland's leading provider of specialist cardiovascular services, Mater Private Network continues to invest in advanced technologies, multidisciplinary expertise and international clinical research, reinforcing its position as a leader in cardiovascular medicine and research and ensuring patients have early access to the latest evidence-based treatments.

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