j

- J
f- r

How to convince patients to take their medicines

CPD IDENTIFYING AND TREATING A FACIAL RASH page 18
ZONE 10 things to know about neuropathic pain page 23

Ask the experts at the ^

C+D Conference
Your chance to quiz the biggest brains in the industry at the largest pharmacy conference of the year
vv v
The C+D Conference
at the Pharmacy Show
NEC Birmingham 10-11 October 201

The C+D Senate Live

The community pharmacy
think-tank

SEE p24 FOR FULL DETAILS

Nurofen Plus provides significantly
greater pain relief* than paracetamol
+ codeine + caffeine 1

Why Nurofen Plus? If you were pain, you'd be scared too - in a pain
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Nurofen Plus because there's no more effective painkiller available

without prescription.
* In a dental pain study

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administration and short-term use only. Adults. 1 or 2 tablets every 4 to 6 hours. At least four hours between doses. No more than 6 capsules in any 24 hour period. Not to be taken
for more than 3 days continuously. The patient must consult a doctor if symptoms persist or worsen, or if the product is required for more than 3 days. Not to be taken less than 4
hours after taking other painkillers. The Elderly: No special dosage modifications are required for elderly patients, unless renal or hepatic function is impaired, in which case dosage
should be assessed individually. Not for use by children under 12 years of age. Contraindications: Hypersensitivity to ibuprofen or other constituent. History of hypersensitivity reactions
(e.g. asthma, rhinitis, angioedema, or urticaria) in response to aspirin or other non-steroidal anti-inflammatory drugs. History of, or existing gastrointestinal ulceration/perforation
or bleeding. Severe hepatic failure, severe renal failure or severe heart failure. In last trimester of pregnancy there is risk of premature closure of the foetal ductus arteriosus.
Onset of labour may be delayed and the duration increased with increased bleeding tendency in both mother and child. Hypersensitivity to codeine, respiratory depression, chronic
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 For three days use only. Can cause addiction.

NUROFCN
PLUS o
specific inhibitors. Female fertility may be impaired by a reversible effect on ovulation. Gl bleeding, ulceration or perforation Caution is required in patients on medications which
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the treatment must be stopped. This medicine contains codeine which can cause addiction if you take it continuously for more than 3 days. If you 'or headaches
for more than 3 days it can make them worse Side Effects: Hypersensitivity reactions may include non-specific allergic reactions, anaphylaxis, 'act reactivity (e.g. asthma,
res|
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drowsiness. Regular prolonged use of codeine is known to lead to addiction and symptoms of restlessness and irritability may result when treatment is then stopped MRRP (excl VAT):
£2.36 (12 tablets) £4.44 (24 tablets) £5.28 (32 tablets) Legal Category: P. Product Licence Numbers: PL 000327/0082 Licence Holder: Crookes Healthcare Limited, Nottingham NG2 3AA.
Date of Preparation: March 2010 References 1 McQuay et al. Anaesthesia 1992;47:672-677.

Adverse events should be reported. Reporting fo

Adverse events should be rep.
 "The little difference that
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Product Information. Panadol Advance 500mg Tablets. Presentation: Paracetamol 500 mg. Contains Pregnancy/lactation: Use in pregnancy should be on doctor's advice. Not contraindicated in breast feeding.

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tension headache, toothache, backache, rheumatic and muscle pain, dysmenorrhoea. sore throat, Steven Johnson syndrome, toxic epidermal necrolysis, bronchospasm and hepatic dysfunction.

feverishness, aches and pains of cold and flu, pain due to non-serious arthritis. Dosage and Legal category: 1 Compack GSL, 32's R Product licence number: PL 0007 /044 Product licence
6's 1
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administration. Adults and children, 1 2 years and over: Two tablets up to four times daily as required. holder: GlaxoSmithKline Consumer Healthcare, Brentford, TW8 9GS, U.K. Package quantity and RSP
Max. 8 tablets in 24 hours. Children 6-12 years: Half to one tablet three or four times daily as required. (excl.VAT): 1 6's Compack £ .23. 32's £2.37. Date of last revision: June 20 0. Panadol is a trade mark
1
1

Do not use for more than 3 days without doctors advice. Children under of the GlaxoSmithKline group of companies.
Max. 4 tablets in 24 hours.
6 years Not recommended. Doses should not be repeated more frequently than every 4 hours, MP3 player supplied will differ from one shown.
Contraindications: Known hypersensitivity to ingredients. Precautions: Renal or hepatic impairment,
non-cirrhotic alcoholic liver disease. Contains parahydroxybenzoates - may cause allergic reactions. Copyright 20 1 0, GlaxoSmithKline MyPharmAssist.co.uk
Interactions: Domperidone, metoclopramide, cholestyramine, warfarin or other coumarin anticoagulants. Consumer Healthcare. All rights reserved.
 5
Have your say on C+D's news. Email us at:

haveyoursay@chemistanddruggist.co.uk

Croup Editor
Gary Paragpuri MRPharmS
020 7921 8045
News Editor
Max Cosney 020 7921 8147 Three seemingly unrelated events - and the PDA couldn't have come at

Features Editor an award-winning pharmacy in a better time (p6) The existing rules
Jennifer Richardson 020 7921 8084 Orkney, the pharmacy supervision that dictate what you can and can't
Digital Content Editor rules, and the latest funding do are over 40 years old and simply
NiallHunt 020 7921 8185
announcement for England's do not fit with what's expected from
Clinical & CPD Editor
Chris Chapman 020 7921 8086 contractors - say a lot about the a modern pharmacy - either by the

Senior Reporter state of play of pharmacy practice. public or by pharmacists.

Zoe Smeaton 020 7921 8141 Let's start with the stunning The overarching rule that one
Reporters Sutherland's Pharmacy, which won pharmacist is in charge of one
Hannah Flynn 020 7921 8194
second place and £2,000 in C+D's pharmacy must remain (Anything
Emily Jones
Platinum Design Awards (p20). else - except in very exceptional
Production Editor
Harriet Kinloch020 7921 8249 There are refits and then there are circumstances - would see patient
Deputy Production Editor complete top-to-bottom overhauls safety incidents go through the
Fay Jones 020 7921 8236 that propel your business into the roof And within this, pharmacists
)

Croup Art Editor

premier league - and in the case of must be given the freedom to
Richard Coombs 020 7921 8240
Sutherland's, it's the latter. delegate work to appropriate staff,
Designers
David Farram 020 7921 8198 Fabulous, eye-catching design so they can spend more time with
Jo Konopelko 020 7921 8196 aside, it's the attention to detail in patients adding the clinical value
Office Manager the way the pharmacy team works that they are trained for and that the
Elaine Steele 020 7921 8110
that stands out. For example, the NHS so desperately needs
(fax): 020 7921 8132
use of tills that can also access the It sounds great and it's a point
elaine.steeleiaubm.com
Interim Sales Director
i PHARMACISTS ARE PMR system at the flick of a switch that has been made countless times
Deborah Heard 020 7921 8119 makes perfect sense. How many before. Pharmacists can deliver more
Advertisement Manager WEDDED TO THE times do you speak to a patient at of the services that the NHS is crying
Daniel Spruytenburg 020 7921 8126
the counter and find that you need but they can't do without
Senior Sales Executive FINAL CHECK AND out for, it

to disappear back into the sustained and fair funding. The

Andrew Walker 020 7921 8123
manner which enhanced
Online Support Operative STRUGGLING TO dispensary to check the patient's ludicrous in

Jonathan Franklin 020 7921 8333 medication or allergy history? services come and then go according
C+D Data
Devi Patel (Operations Manager)
FIND AWAY THAT Sutherland's Pharmacy's solution to PCTs' debt levels is an absurd way
seems so obvious that you wonder of incentivising pharmacy. It does
020 7921 8235
Michael Pavey (Business Development ALLOWS THEM why it isn't more widely used. little besides confirming what

Manager) 020 7921 8422 Perhaps it's because the average pharmacists already know about
Colin Simpson (Price List Controller) TO ADD REAL, pharmacy is dispensing around where PCTs' priorities lie.

020 7921 8667 5,000 items per month and because Against this background of where
Darren Larkin (Electronic Data
MEASURABLE, AND pharmacists don't fancy a criminal the sector needs to be, the news
Controller) 020 7921 8294
conviction if they make an error The that £140 million is being clawed
Mira Inameti (Data Specialist)
020 7921 8115
REIMBURSABLE end result: rather than spend more back by the Department of Health
Sandra Drawbridge (Input Clerk) time with patients, pharmacists are doesn't exactly inspire hope (p6).
020 7921 8674 PATIENT BENEFITS wedded to the final check and PSNC hopes to begin discussions
Projects Director
struggling to find a way that allows on funding reform to reward quality
Patrick Crice MRPharmS
them to add real, measurable, and and outcomes. It can't come soon
020 7921 8335
TrainingDevelopment Managers reimbursable patient benefits. enough.
SaraMudhar MRPharmS So the current focus on
020 7921 8414 supervision coming from the RPSCB Gary Paragpuri, Editor
Kinna McConochie MRPharmS
020 7921 8413
Training Sales Manager
Paul Thorp 020 7921 8426
Projects Administrator
Pauline Sanderson 020 7921 8425 6 Contractors face £140m Cat M hit 15 Update: medicines adherence
Projects Admin Assistant
LewisSwan 020 7921 8420 Convincing patients to take their medicine
7 Calls for rosiglitazone to be withdrawn
Production Controller
Christine Langford 020 7560 4133
18 Practical approach
8 Fee flouting restoration bid fails
Managing Director What might be causing a teenager's flaking rash?
Phil Johnson 020 7921 8106 10 Your guide to pharmacy PR pilots
Email 20 Platinum Design Awards
firstname. surname 12 GSK launches free pain podcast A winning redesign on remote Orkney
@ubm.com
14 Xrayserand David Reissner 23 Ten things about... neuropathic pain
Key points in light of the revised Nice guidance
25 Classified

30 Postscript

® UBM Medica. Chemist+Druggist incorporating Retail Chemist. Pharmacy Update and Beauty Counter Published Saturdays by UBM Medica. Ludgate House, 245 Blackfnars Road. London SE1 9UY. C+D online at:
www.chemistanddruggiSt.co.uk. Subscriptions: With C+D Monthly pricelist £250 (UK), without pncelist £205 (UK) ROW
price £365. Circulation and subscription UBM Information Ltd. Tower House. Sovereign Park. Lathkill St.
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Press. Queens Road, Ashford TN24 8HH Registered at the Post Office as a Newspaper Volume 274 No 6763

11.09.10 5
Contractors facing category M
hit of £140m under funding deal
Prepare for clawbacks now, warns PSNC chief, as individual pharmacies face £1 3,000 cost
Chris Chapman
chris.chapman@ubm.com

Contractors in England are facing a

category M clawback of £140 million
under the latest contract deal, with a

£60m hit scheduled for October,

PSNC has announced.
The category M deductions will
come in three waves: £60m taken in
October, a further £60m in January
and the remaining £20m over the
course of the next financial year.
Pharmacies were due to pay back
all £140m in excess purchase profits
in 2010-2011. But pharmacy
minister Earl Howe has allowed
£20m to be carried into 2011-2012
to "smooth the impact", PSNC said.

The clawback works out at around

an extra £13,000 for each of the
10,500 pharmacies in England. payments come through. We outcomes, Mrs Sharpe added. cash flow is difficult to manage...
Overall funding for community recognise the impact that category Mike Hewitson, of Beaminster anyone who invested in the past
pharmacy services in England for M adjustments will have in the Pharmacy in Dorset, said he was three months has just seen their
2010-11 has been agreed at second half of the year, and we urge "gutted" about the size of the hit. cashflow wiped out," he said.

£2.49 billion. This is an increase of contractors to prepare for this now." "That's a member of staff. And why? PSNC said the results of its cost of
around £170m on the £2.32bn sum However, contractors were Because we're buying better than service inquiry would not be known
agreed for 2009-10. fortunate the clawbacks were spread [the government] thinks we can." for "several weeks".
PSNC chief executive Sue Sharpe out, and not combined into a shorter Independent Pharmacy However, Earl Howe has agreed to
warned contractors to prepare now timeframe, Mrs Sharpe said. Federation chair Fin McCaul, called reserve £250m, a proportion of

for the financial loss. PSNC was expecting to discuss for an overhaul of the contract to which will be held as a risk share, in

She said: "Contractors will no funding reforms with the alleviate the problems. "We're stuck the event the inquiry shows
doubt feel the effects of excess Department of Health in the near in swings and roundabouts, so there underfunding for the sector, the
margin recovery when January future to reward quality and is no confidence in the business and negotiating body added.

Remote supervision debate

Errors reprieve due in heats up at RPS conference
autumn health bill Remote supervision divided debate
among attendees at a fringe session
The debate comes ahead of an
expected government bid to review
The government will put a clause in would require legislative change. on supervision at the RPS existing supervision laws next year.
the health bill this autumn to But speaking to C+D in response Conference in London this week. Changes could see pharmacists
decriminalise dispensing errors, toMs Gordon's comments, the Chaired by vice-chair of the able to run pharmacies without
the chief executive of the Royal MHRA said: "While we do not think English Pharmacy Board Sid Dajani, being physically present.
Pharmaceutical Society has it will be realistic to achieve the debate centred on the eight This remote supervision concept
claimed. legislative change via the health bill principles for supervision released by has been heavily criticised by the
In her keynote address to the RPS the MHRA will consider any the RPSGB last month. These include industry, but attendees from Wales
Conference this week, Helen Cordon possibilities that could deliver the a declaration that all patients should and Scotland argued the concept
said: "We continued to push for necessary change in advance of the have their medicines supply could ensure patients in remote
dispensing errors to be decriminalised bulk of changes arising from the overseen by a pharmacist. parts of the UK had access to services.
and the latest information we have review of the Medicines Act." Independent pharmacist Graham Director of pharmacy for NHS
is that the government will put a A spokesperson added: Phillips responded: "I am not willing Highland John Cromarty said:

clause in their new health bill this "Discussions over the autumn will to remove the pharmacist from the "Remote access is a problem, the
autumn do as we asked."
to need to take account of the wider scene. As a clinician I am not willing area I cover has an area of 12,500
However, it remains unclear how work of the review to ensure that the to do that. square miles. Many patients have no
quickly any change to the law will overall approach taken is coherent." "You can't say you can be out of access to community pharmacy."
arrive. The MHRA told C+D this July Ms Gordon's comments came in the pharmacy for two hours as you Debate attendees also questioned
that any changes to the Medicines her first public speech as Society don't know what's going to happen how the RPS will engage members
Act made before its 2012 review chief executive. HF in those two hours." in the supervision consultation. HF

S 11.09.10
 Become an MUR master. Register for a C+D training course at
www.chemistanddruggist.co.uk/stafftraining

Expert panel told MHRA

to abandon rosiglitazone
Drug remains available despite
Chris Chapman
chris.chapman@ubm.com
place on the
CHM
UK market"
an investigation by the BMJ under
safety warning two
in July,
months ago
monitoring requirements of the drug
on July 26.
PCT
INVESTIGATION
the Freedom of Information Act Rosiglitazone is currently under
Drugs watchdog the MHRA was discovered. review by the EMEA after two papers Did you know some PCTs only
advised almost two months ago that Rosiglitazone is still available in sparked concerns over the drug's spent 2p per patient on pharmacy
rosiglitazone should be withdrawn the UK, but the MHRA has passed its cardiovascular risk. enhanced services last year? We
as its dangers outweigh its benefits, concerns to the European Medicines An EMEA committee was due to lift the lid on PCT commissioning
it has emerged. Agency (EMEA). conduct a risk-benefit review of at the C+D Senate Live on
The UK's Commission on Human The MHRA confirmed the CHM rosiglitazone last Wednesday, with a October 11 at Birmingham's NEC.
Medicines (CHM) told the MHRA statement, adding it had advised final verdict on the drug's fate Get your free ticket at

"the risks of rosiglitazone outweigh healthcare professionals on scheduled for September 23. www.chemistanddruggist.co.
its benefits and it no longer has a cardiovascular restrictions and Currently, the EMEA advises uk/thepharmacyshow
healthcare professionals "to strictly
Quiz the RPSGB boss
Pharmacist meds management can stop follow the current restrictions in the
product information" when C+D is offering two pharmacists
nine in 10 care home errors, trial reports prescribing the drug. an opportunity to interview
Pharmacists can cut care home Internal medicines errors such as GlaxoSmithKline, which Society chief Helen Gordon. To
medication errors by 91 per cent if changes in dose, medication or out manufactures rosiglitazone under enter simply email your top five
given full responsibility for of date records were reduced from the brand Avandia, refuted the questions for the new RPSGB boss
medicines management, a trial 69 at baseline to only six during the claims there was a lack of to gary.paragpuri@ubm.com
scheme has found. trial period. safety data on the drug, and
The four-month trial, by The trial follows an alert from urged patients who may have NCSO endorsements
Midhurst Pharmacy in London, the Department of Health in concerns to discuss treatment The following are allowed NCSO
introduced an intensive January, warning that older people with their GP. endorsements for September
pharmacist-led pharmaceutical in care homes were exposed to a "We continue to believe that prescriptions in England and
intervention programme at a 69- higher rate of medication errors Avandia is safe and effective when it Wales: dexamfetamine 5mg
bed higher-dependence care home. than those in the community. EJ is prescribed appropriately," the tablets, gabapentin lOOmg and
manufacturer added. 300mg capsules, and ofloxacin
400mg tablets.

Pharmacy iPod winner

Congratulations to Darshan
gunmen jailed Negandhi of ABC Pharmacy who
has won an iPod after completing
Two men have been jailed for C+D's Stock Survey.
robbing two Belfast pharmacies at
gunpoint last year. Scots board wants access
Glen Henry Beattie, 21, pleaded The RPSGB Scottish Board will

guilty to two counts of robbery, one campaign for greater access to

at a pharmacy on Ballygomartin health records under its pharmacy
Road, Belfast, on June 17, 2009 and manifesto 2011. Board chair
one at Woodvale Pharmacy, Enfield Sandra Melville made the call in

Street, Belfast, on July 1, 2009. her RPS conference address.

He was sentenced to eight years
in Crown Court.
prison at Belfast First CPD hearing
Andrew Peden, 24, pleaded not The case against the first

guilty to the robbery at Woodvale pharmacist to be referred to

Pharmacy, and was found guilty of the RPSGB's Investigating
robbery and possession of a pistol Committee for breaching CPD
and a crossbow. He received a 10- standards was heard this week,
year jail sentence. as C+D went to press.
Mr from the
Beattie stole £192
pharmacy on Ballygomartin Road, Boots plans to roll out a raft of cancer support services under a three-year deal The graduates
with a leading cancer charity. Boots marketing director Elizabeth Fagan (centre
and the two gunmen took £115 from The first MPharm graduates have
right) and Ciaran Davene, chief executive at Macmillan Cancer Support (centre
Woodvale Pharmacy. left) celebrate the partnership that will see 15,000 Boots pharmacy staff trained qualified from Wolverhampton
Pharmacist John Dobson of by Macmillan. Early work will focus on the support and services that are available University. Thirty two students
Woodvale Pharmacy said: "They through Macmillan. Future targets include extensive cancer advice and support collected their honours last week.
were both wearing ski masks, which services. The partnership comes as a YouGov poll revealed that cancer is the

added to how biggest health worry for over half of the population. Boots staff will also raise
scary the robbery was More on these stories online
funds for Macmillan, aiming to clock up 290,000 miles - one for every person
as you can't read their facial www.chemistanddruggist.co.uk
diagnosed with cancer in the UK each year MC
expressions." HF

1 1.09.10 7
 Pharmacist investigated for CPD breaches
NEWS www.chemistanddruggist.co.uk/news

Dispensary
p harmadst who floute<J
Did you get a longer
break over the bank
fees fails restoration bid
holiday or did you work? Applicant must wait further six months to re-apply, says committee
A pharmacist who continued to 2009, despite being removed from that he had no money to pay the
"I took a practice despite failing to pay his the register for non-payment of fees. retention fee in June 2009.
longer break retention fee has failed in a bid to be During the locum shifts he had Mr Johnston was fully aware of
and went to restored to the register dispensed, on one occasion, schedule the implications for him after his
Spain with the Damien Johnston, of Belfast, had 2 controlled drugs, the committee name was removed from the
kids over the committed a serious abuse, a heard. register, the committee was told
bank holiday, Northern Ireland statutory Mr Johnston deliberately misled The statutory committee
as they were committee hearing ruled. his employer about his unregistered acknowledged Mr Johnston's full

off." He had flouted a registration status, the hearing was told. acceptance of the facts and his

Culab process that assured the public that Authorities were alerted after a otherwise unblemished record.
Chauhan, those acting as pharmacists were pharmacy annual return showed he Mr Ferris said his removal should
Malvern Pharmacies Croup, properly accredited, the committee had been employed as a locum. not be forever and he could re-apply
Malvern chairman Tim Ferris said. Mr Johnston fully accepted he had in six months. The verdict came as
Mr Johnston worked as a acted in a way that constituted PSNI removed 18 pharmacists from
"I usually pharmacist on seven occasions misconduct at the hearing. the register this September for
don't work between September and December He offered no defence other than failing to pay fees. Contrib
Mondays and
only work four
days a week. Clinical debate C+D's Chris Chapman looks at the evidence behind the headlines
However, we
have a
rota for bank
holidays and
shift

I
How to prove you're competent
had to work Healthcare Council. This includes the pharmacy world, too. Only
on the Monday last week. So I anyone providing aromatherapy and pharmacists who decide to join
actually worked longer hours!" reflexology, and will soon include the professional leadership body
Rachna Chhatralia, Day Lewis, acupuncture and general 'healing'. will have the post-nominal
Wellington, Surrey Former health minister Andy MRPharmS to show patients as
Burnham argued for the move, added 'proof. But it's not a legal
recognising that herbal remedies are requirement to join the new

Web verdict unlicensed, but that the register

would "increase public protection,
Society, or a measure of
professionalism or added

Yes, I took a longer break 54% but without the full trappings of competence. It's the GPhC
professional recognition". registration that matters to

Unsurprisingly, this suggestion patients.

No, I had to work 46% caused a bit of a stir in science By keeping a register, healthcare
How can a patient be sure you circles, with fans of evidence-based professions make a pact with
know what you're talking about medicine warning that the scheme the public. They say that this
Armchair view: Nearly half of when it comes to medicines and would be based on accreditation, not person - doctor, dentist,
pharmacists are providing cover on health advice? You might say the whether treatments actually work. pharmacist or nurse - is at a set

bank holidays according to this answer is simple: you have an And as charity Sense About Science, competency for providing
week's C+D survey. Only 54 per cent easily checkable registration which this week demonstrated evidence-based healthcare.
of respondents reported taking a number. But, actually, it doesn't against the suggestion outside the A register of complementary
longer break over the August bank mean a thing. Department of Health, points out, a therapists would only add
holiday weekend. In April, the previous member of the public won't know confusion to an already mudded
Next week's question: government made tentative plans the difference between a recognised picture, and potentially be to the
As the RPSGB prepares to relaunch to ensure all practitioners of health professional and someone detriment of patients.
as a new-look leadership body, we complementary therapy must registered to provide a
ask, does the Society deserve a be registered with the complementary therapy. Chat with Chris on Twitter:
second chance? Vote at Complementary and Natural There are added complications in www.twitter.com/CandDChris
www.chemistanddruggist.co.uk

David Reissner: The inside track on stat comms

C+D Keynote Conference at the Pharmacy Show
October 10-11 The NEC Birmingham
Register for your free ticket at www.chemistanddruggist.co.uk/thepharmacyshow
r
8 Chemist+Dru 11.09.10
"Piarrhoea Pialo 6-

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hoea is as difficult to talk about as it is to spell)

new "Diarrhoea dialogue" initiative has been designed to support you through those awkward conversations,
providing you with the tools to help offer your customers the advice they need.

For more information call 01344 864 042 or visit www.imodium.co.uk

Imodium
PLUS CQPL£TS
Loperamide hydrochloride
& Simeticone
 6

_ Watch the pharmacy tsar on the new pharmacy regulations

NEWS www.chemistanddruggist.co.uk

Your guide to pharmacy PR pilots

Pharmacy has always struggled to match higher profile GPs and nurses in the publicity stakes.

The 2008 white paper promised a remedy with a PR campaign for the sector. Four PCTs have
been given £1 52,000 to pilot the initiative. Hannah Flynn checks on their progress so far

Location: Location: PCTVERDICT:

Dudley PCT Portsmouth PCT "We wanted an
overarching
The campaign: The campaign:
campaign. We have
To get more 1 A 'Healthy Living'
our 'Healthy Living'
to 24-year-olds campaign across
pharmacies, but we
into pharmacies all pharmacies
want their work
Budget: to have a halo
£40,000 £35,000 effect on other
pharmacies in the area. Areas of deprivation in our
How have they PCT VERDICT:
How have they PCT had high numbers of people attending A&E who
promoted promoted
"We have been doing some research into what barriers didn't need to be there, and the objective of this
pharmacy? pharmacy?
there are to people in the 16 to 24 age group in campaign is to make people aware of the health
Planning social Advertising on
accessing pharmacy. We found people don't know expertise pharmacy can deliver."
media campaign, buses, road show,
what is offered at pharmacies and are unsure about PHARMACIST VERDICT:
attending social website launch,
the level of confidentiality. They wanted to know if "We provided a pharmacist and a technician to the
centres radio advertising,
speaking to a pharmacist was confidential, like campaign's road show, which I think helped increase
interviews,
Planned speaking to a GP We are planning four one-day general awareness. I think the campaign may, in an
in-store branding
launch: communication sessions with pharmacists and counter indirect way, benefit us. The full impact of the PR
December 2010 staff to ensure young people are communicated with Launch: campaign is yet to be seen, but bringing a banner to
effectively." Launched August the public about pharmacy must be a positive thing."
Baldev Laly, owner of Lalys Pharmacy, Portsmouth

Location:
South West Location: PCTVERDICT:
Essex PCT North Yorkshire "We hope this project will shed new light on the
and York PCT reasons why men in this age bracket don't use
The campaign:
community pharmacies to their fullest potential. By
The PCT aims to The campaign:
taking a social marketing approach to this project, we
work with The PCT plans
hope to uncover men's perceptions towards community
community to increase the
pharmacy, the barriers that prevent them using
pharmacists number of
pharmacy and explore ways to remove these barriers.
to reduce 45 to 55-year-old
"Preliminary engagement with pharmacy staff in the
cardiovascular males accessing
Scarborough area has already revealed some
disease among pharmacy advice
interesting insight. One area we are planning to
disadvantaged and services
PCT VERDICT: explore further is the role that partners play in
residents
"NHS South West Essex believes that community Budget: influencing the health of men. We are also exploring
Budget: pharmacists can play an increasing role in improving £40,000 aspects such as accessibility and the perception that
£37,000 access to health services as they are conveniently pharmacy could be seen as a more female-friendly
located within communities and often have extended
How have they environment."
How have they opening hours, making it easier for workers to access
promoted PHARMACIST VERDICT:
promoted this service.
pharmacy? "The campaign will help as it offers a whole package to
pharmacy? "After a successful pilot, involving20 pharmacies
Local newspapers
our customers, and encourages people from all
An integrated and community
in Basildon and Tilbury, NHS South West Essex is avenues of life to come
The 45 to 55 age group
in.
social marketing networks and
refining the service. The PCT worked closely with traditionally under-attends and this campaign will give
campaign clubs
participating pharmacists to help them introduce the us another group to work with. It is incredibly

Planned service, and by training counter staff. However, where Planned satisfying as a pharmacist to be able to engage in
J

launch: pharmacists have underperformed, the testing kit launch: health prevention with an individual before they come
Late 2010 will be reallocated to pharmacists in Grays, an area of November 2010 in with a health issue."
high deprivation." Sandra Hutchinson, Boots Pharmacy, Scarborough

The C+D Daily

Get the latest news, views and comment straight to your inbox I
Irforffl*
800

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10C ernist : Druggist 1 1 .09.1

I
 Trade up tjour customers to

Canesten Combination treatments

IS The Canesten Combination Range

Combi Cream Combi Duo

Trade up Trade up Trade up

Pessary to Combi Internal Cream to Oral C apsule to
Cream Combi Oral & Cream Duo

Pessary Intern. 1

( ream

3w

i brushan internal infection, but customers

is

often present with external symptoms too.

For more information on the Canesten range please visit the Canesten website at
www.canesten.co.uk/hcp C gyi24 j une 2010
 Check what's on TV this week
PRODUCT NEWS www.chemistanddruggist.co.uk/prodnews

Rt ecu mill;
GSK launches free pain podcast
Should homeopathic GSK Healthcare has launched a
podcast to assist pharmacists and Market focus
remedies be labelled pharmacy assistants in pain
consultations.
'placebos'? • £21 1m- total adult
The free 10-minute podcast will
analgesics value.
be delivered by the Panadol brand
"I don't think and offers interviews and case
• 3 per cent - increase in the
we should studies for pharmacy teams to use
total adult oral analgesics
label them as training to improve their pain
market in 2009.
as placebos consultations.
as these The 10 Minute Pain Podcast is
Source: Kantar WorldPanel value sales
products are delivered in a disposable MP3 player, 52 weeks to November 29, 2009
marketed as says GSK Healthcare.
containing The free podcasts will be available
small upon request through trade GSK Healthcare
amounts of advertising, direct-mailed reply paid Tel: 0800 783 3927
medicines, so if we label them as on GSK's pharmacy
cards, www.mypharmassist.co.uk - or by www.mypharmassist.co.uk
placebos that is misleading." community website - calling 0800 783 3927. ukpharmassistteam@gsk.com
Bhavesh Patel, Pharma
Healthcare, Canvey Island, Essex
ICaps website supplemented with new advice
"Labelling
them Alcon has updated the The website also contains
placebos may website of its eye product and stockist
encourage supplement product ICaps. information, according to the
misuse, as The consumer website company.
they do has been designed to offer It can be accessed at:

contain advice to customers on eye www.icapsinfo.co.uk.

chemicals, health and nutrition, The move follows the
some of according to an ICaps introduction of a one-a-day
them are spokesperson. formula earlier this year.

suspended in alcohol. You don't It now has an 'Ask The

want people to think of medicines as Expert' function, offering Alcon
completely benign." advice from a research Tel: 0800 092 4567
Ajith Adai, Chernistree Pharmacy, optometrist. www.icapsinfo.co.uk
St Albans, Hertfordshire

Makeover for mypharmassist Kalms one-a- in

Web verdict GSK Healthcare has relaunched its pharmacy sector, the company said night product
online pharmacy community it has created a more user-friendly
Yes website, www.mypharmassist.co.uk site, including a simplified LanesHealth is launching Kalms
Acting on feedback from the registration process, faster log in and Night One-a-Night, a herbal product}
quicker access to all areas for the relief of sleep disturbances.
No The launch be supported by
including training. will

CPD and other pharmacy television advertising for the range, a

staff training are available in PR campaign and POS to support
Armchair view: The pharmacy a variety of formats - the launch including pens, shelf
community is split over the 10. including e-zines, interactive strips, signature mats, post-it notes
suggestion by the BMA that e-learning modules and and leaflets, says the company.
pharmacists should label podcasts. Kalms Night is a one-a-night
homeopathic remedies
according to our poll.
'placebos',
m It is

download
also possible to
free display
formulation containing dry extract
of the herb valerian.

Next week's question: material from the website.

Are there too many cough and cold Price: £4.99/21
remedies to choose from? Vote at GSK Healthcare 356-6148
Pip code:
www.chemistanddruggist.co.uk/ Tel: 0845 762 6637 LanesHealth;tel: 01452 507458

prodnews www.mypharmassist.co.uk www.kalmssleep.com

General
Pharmaceutical
Check your mail for your
Council GPhC information pack!
12 11.09.10
Fluoride Mouthrinse Winter needn't
- The Evidence be woeful
Our oral health as a nation has

improved considerably over

the last three decades. Today,

in most instances, dental

diseases are preventable by

adopting appropriate daily

I FluoriGari •
FluoriGard I
I FLUORIDE HltJSEjy DAILY DENTAL RlNSE I
oral care regimes and regular
visits to the dentist. Winter is approaching and
Iimagine that you are all in
In a review paper on how
the throes of preparing for
best to prevent a number
a change of ailment to treat
of oral diseases including Ajit Malhi, head of
as the long, dark nights marketing services for
dental caries (tooth decay),
approach. AAH Pharmaceuticals
the strength and extent of
Alw.iv> ip.hI Ihp label
On that note we're delighted
evidence supports advising
here About Health that
at All
patients to use appropriate fluoride mouthrinses to help prevent dental
so many of you have prepared well for the winter and signed
caries. It states that:
up to deliver our award-winning flu vaccination service.
• Mouthrinses containing 0.05% sodium fluoride (225ppm fluoride) for This is excellent news, but can't stress strongly enough
I

daily use have been shown to reduce tooth decay significantly in the the importance of marketing the service to push this out to
permanent teeth of children over 6 years and adolescents. your communities with added gusto. Recent figures released
by Novartis Vaccines, our partner in delivering the flu
• Fluoride mouthrinses, in addition to daily use of fluoride toothpaste, are
vaccination service, demonstrate that 90 per cent of patients
also beneficial to adults and the elderly.
receiving the flu vaccination in a pharmacy would return for

• Ideally mouthrinses should be used at a different time of day to twice further vaccinations they were made available.
if

daily toothbrushing with fluoride toothpaste to maximise the benefit of However, the good work that you all do to promote
additional fluoride.
the service has been highlighted superbly by the 37 per
cent who said that they only had the flu jab because the
The Department of Health publication: 'Delivering Better Oral Health - pharmacy was promoting it.
2
An Evidence-based toolkit for prevention' includes guidance to dental Evidence indeed that good marketing works well and this
professionals on prescribing a daily fluoride rinse containing is an ideal time to sing about the service and its convenience

0.05% fluoride (225ppm F) as a way of increasing fluoride availability to to customers both loyal and new.
prevent caries. Accompanying the impending flu season will be the fourth
issue of our All About Health magazine. Judging by the
Colgate FluoriGard fluoride mouthrinses contain 0.05% fluoride (225ppm).
requests that we get to fulfil additional orders with you, this is
Colgate FluoriGard Daily rinse is clinically proven to reduce caries.' Colgate
clearly going down a treat with your customers.
FluoriGard Alcohol Free rinse offers fluoride protection in a formulation that
This issue brings more celebrity health secrets from
does not contain alcohol, making it ideal for patients who may prefer to
Ben Fogle and former spice girl turned TV hostess Emma
choose an alcohol free option.
Bunton. It also features a winter colds special to coincide

For further information, please call the Colgate Customer

with new point of sale materials landing with you.
These are exciting times for pharmacy and this is the
Care team on 01483 401 901 or visit time have sat down to write this article since the
first I

www.colgatepharmacy.co.uk changes in Government and since Andrew Lansley set about

restructuring the NHS.
There are sniffles and sneezes awaiting us on the horizon
Colgate FluoriGard Daily rinse
and some questions to be answered in the corridors of
Legal Status: GSL, PL 0049/0012
power, but let's tackle them head on and make the most of
References: 1. R M Davies The Prevention of Dental Caries and

Periodontal Disease from the Cradle to the Grave What is the

how we can guide our customers this winter and beyond.
Best Available Evidence? Dental Update, May 2003 1 70- 701

2. Delivering Better Oral Health-an evidenced based toolkit for

For more information:
prevention, September 2009 3. Marinho et al, (2002), Email: allabouthealth@aah.co.uk
Cochrane Database Syst Rev no 3
www.allabouthealth.org.uk

AAH customers should contact their

AAH Business Manager to get involved

Co All About
 What do you think?
OPINION haveyoursay@chemistanddruggist.co.uk

Assessing the threat to your business

They say stressed is when you wake up screaming, second was more sinister. The lead CP from our
then realise you weren't actually asleep. An image local surgery came in, and expressed the partners'
we may all be familiar with, but I've become anger that I had appealed the decision for a
concerned recently not about stress insomnia, but contract in their surgery. "This is costing us time
that pharmacy is sleepwalking into a nightmare. and money," he fumed. As my heart bled for them,
Our PCT has started to widely publicise its I explained how this move could reduce my
pharmaceutical needs assessment (PNA), the business by a third and that, unlike them, I did not
document that will shape not only what services have an NHS pension. I also explained that we had
need be commissioned from pharmacies, but also not done it lightly or spitefully. We shook hands,
where. In many quarters this was hailed as a relief and he left with better understanding, but as he
from the uncertainty of the current "necessary or turned to go his parting words were: "We will have
expedient" lottery, as it is supposed to make for a pharmacy, whatever happens."
granting of contracts based on assessed need. This And that threat is present in the PNA for all of
was supposed to mean that a neutral body - the us, seem aware of the power of this
yet so few
primary care trust - would assess where patients seemingly innocuous document - the conclusions
needed services, and so the geographical spread of which are not open to appeal. Despite
would be dependent on population requirements numerous articles in C+D, my fear is that -
rather than where was most profitable. distracted by the countdown to the CPhC and yet
All well and good, you may think. But then our more new guidelines - contractors may be looking
current chimera government decided to do away the wrong way, and not see that someone new is

with PCTs, and replace them with CP going to assess the value of their service provision
commissioning groups. Suddenly the whole and thus the value of their business. So when your
premise changes again as interpretation of the PCT asks for contribution make sure you respond,

"HIS PARTING WORDS PNA becomes

interpretation
all,

in
and
many
I'd bet that the
cases will be that the
because if you think you're the only interested
party - well, dream on!

WERE: 'WE WILL HAVE A greatest need for pharmacy services could be
within any number of CP practices. "Oh no," hear I What's happening with the PNA
PHARMACY, WHATEVER you cry, "of course that won't happen..."
in your area?
Since owning Xrayser pharmacy, have been I

HAPPENS"' threatened twice. The first was the ubiquitous haveyoursay@chemistandruggist.co.uk

addict with used needle and syringe, but the

How do the new GPhC standards measure up?

At first sight, the CPhC standards are obligation to make sure their spell out a foolproof method of
rather like motherhood and apple professional judgement is not record-keeping The nearest it got
pie: hard to find anything to disagree affected by organisational interests was to encourage the use of
with. Even though they largely or targets; and they will have a duty 'dispensed by' and 'checked by'
replicate the RPSCB's standards, a to challenge the judgement of boxes on dispensing labels, but the
fresh reading and some small colleagues and other professionals if system only works if individuals
changes, mean there are some eye- there are reasons to believe their initial the boxes in an identifiable
catching items. decisions could affect the safety or way - and if the dispensing container
For example, pharmacists and care of others. has not been discarded. The CPhC
pharmacy technicians must keep I also hope there will be guidance repeats the obligation but places it

full and accurate records of the to explain what the standards mean on the shoulders of pharmacist
professional services they provide. I when they say that, in addition to owners and superintendents.
realise that dispensing is invariably cases where they have consent or I wonder if the CPhC recognises
recorded in the PMR (although I are required by law, they may only the practical difficulties in

sometimes see problems because disclose confidential information in maintaining a retrievable record of
the date of dispensing is not "exceptional circumstances". which pharmacist checked every
"I FORESEE SOME
necessarily the date of supply to a RPSCB standards required single prescription. Superintendents
patient). There is a reason to pharmacists in positions of authority can put systems in place, but it
REQUIREMENTS
document when payment - including responsible pharmacists
services
- to ensure there
should be up to the responsible
WILL CAUSE TENSION
depends on having a record. But do is a retrievable pharmacist to implement them.
all pharmacists record the advice record of the pharmacist taking David Reissner is a specialist in
IN THE WORKPLACE,
they give, or when unwanted responsibility for the provision of pharmacy law and head of
medicines are received for disposal? each pharmacy service. This has healthcare at Charles Russell LLP HOWEVER HIGH-
I foresee some requirements will caused difficulties when an error is (www.charlesrussell.co.uk/
cause tension in the workplace, made and no one can identify which pharmacy). Contact him on 0207 MINDED THE
however high-minded the principle. pharmacist was responsible 203 5065 or email david.reissner@
For example, pharmacists have an The Society was never able to charlesrussell.co.uk PRINCIPLE"
14 Chemist 11.09.10
 CLINICAL CLINICAL BUblNtbb CLINICAL

15 Medicines adherence ^ 18 Seborrhoeic dermatitis r 20 Sutherland's Pharmacy 23 Neuropathic pain

Your weekly CPD revision guide

Medicines adherence
How pharmacists can convince patients they need to take their medicine
Parastou Donyai PhD, MRPharmS effective for all patients, conditions and settings
Comprehensive interventions, combining

60-second At the beginning of 2010, the all-party pharmacy

group met to discuss pharmacists' roles in
cognitive, behavioural, and emotional
components, are thought to be more effective

mary improving medication adherence. Three areas for

improvement were highlighted:
than single-focus interventions.
community pharmacist is
Realistically, a

unlikely to have much

education and training - to increase control over social and economic or condition-
pharmacists' confidence when discussing related factors However, there are some ways in
u read this article? medicines with patients which the pharmacist's own behaviour, therapy-
® practical tools to help pharmacists monitor and related and patient-related factors could be
This CPD article will help you develop
regulate adherence tackled to improve adherence.
skills to improve medicines adherence by • universally commissioned initiatives to help

working with patients. It will cover the adherence.

It was also suggested pharmacists should spend According to the WHO, adopting certain
ons for non-adherence, and coaching
more time talking to patients newly prescribed communication styles with patients is proven to
ues to improve concordance. medicines for long-term conditions. Encouraging work. Tactics include:
adherence means more than just giving • making sure your patients are satisfied with the
information; it involves telling patients a story service you generally provide
hu are patients about their treatment that convinces them there is talking positively
need providing information
non-adherent? a for it.

Adherence is the extent to which patient asking patients specific questions about

Factors that affect adherence include behaviour matches the recommendations of a adherence
healthcare provider. A distinction is often made i following patients up, building a partnership
social and economic factors, lack of
between intentional and unintentional non- being warm and empathetic and providing
knowledge from healthcare team members, adherence. 12 With intentional non-adherence, emotional support.

condition-related factors, therapy-related the patient has decided not to follow the Behavioural science also offers useful theories,
recommendations, whereas with unintentional models and strategies for impacting on patient
factors and patient-related factors. These
non-adherence the patient either forgets and/or is behaviour. Research focused on changing patients'
factors are complex so no single not paying attention. Sometimes both elements attitudes and behaviour has shown the following
intervention is suitable for all patients. may be at play. can work:
• promoting self-care and enhancing patient
Tackling deliberate non-adherence could Adherence factors responsibility
involve discussing patient beliefs, while Non-adherence to medicines is a problem e increasing concern about the consequences of

forgetful patients may benefit from worldwide. The World Health Organization the disease without treatment
(WHO) published a comprehensive report on • enhancing the perceived value or confidence of
reminder technology.
medicines adherence in 2003 that outlined why treatment
patients fail to take their medicines and provided • providing clear patient instructions - start early,
some possible solutions. 3 ideally when a new treatment is prescribed.
at techniques can I use? Adherence is affected by the interaction of five For therapy-related factors, pharmacists should:
key dimensions: • educate the patient about their medications and
g techniques can improve "
social and economic factors - eg poverty, the conditions for which they are prescribed
cordance. These include weighing pros illiteracy, access to healthcare and medicines, i review the patient's medication history

id cons and encouraging patients to effective social support networks, cultural beliefs • continuously monitor the patient's therapy
about illness and treatment • screen for potential adverse effects
step into the role of others affected by
healthcare team and system-related factors - « monitor the patient's ability to take their

ir treatment. eg lack of knowledge, lack of tools, poor medications correctly and to adhere to the
communication prescribed therapies.
5 condition-related factors - eg depression has a In 2008, researchers in Denmark published a

et Update emailed to you each week, considerable effect on adherence generic adherence programme to help improve
ister for C+D's CPD newsletter at • therapy-related factors - eg the dose frequency patients' chronic medication use. Taking the WHO
www.chemistanddruggist.co.uk/register and the incidence of side effects recommendations, they produced an
» patient-related factors - eg lack of information individualised, multi-dimensional adherence
and skills, difficulty with motivation and self- counselling programme. 4
efficacy, and lack of support for behavioural The process of the intervention was summarised
Supported by
changes. in the following short formula: "Find the patient,
As these factors are complex, no single get the story, check for errors, find the resources
GENUS PHARMACEUTICALS
intervention or package of interventions is together with the patient, share goals, agree

11.09.10 15
 ZONE V 15 Medicines adherence ^ 18 Seborrhoeic dermatitis ^ 20 Sutherland's Pharmacy 23 Neuropathic pain

on plan, get it done and follow up". According to the researchers, intentionally non- studies exists, the inconclusive nature of the
The model begins by allowing patients to talk adherent patients have typically made their evidence means there is no definitive best practice
about their medication use. The idea is that letting decisions based on several subjective feelings and advice. Complex interventions that take account of
patients tell their story helps pharmacists identify experiences (eg misunderstandings, negative individual patient situations combined with
key issues and then helps the patient create a more feelings, lack of support, lack of confidence in the enhanced delivery/communication skills might
suitable version of the story, with the right healthcare system and personnel, lack of work in some cases, where story telling and
resources and solutions. In this next stage of the confidence in medications, low self-esteem, bad discovering patient resources could lead to an
model the pharmacist uses 'coaching' techniques, experiences). With unintentional non-adherence, agreed action plan and further follow-up.
in effect asking a series of questions to help the forgetfulness is often the problem and the patient References are online in the full version of this
patient realise the answers for themselves. may only need help for the execution of the article at www.chemistanddruggist.co.uk/update
Patients can choose from among the solutions treatment - hence packaging and reminder
they have come up with during the session, based technologies may be helpful. Therefore very Parastou Donyai is a lecturer in pharmacy
on what they feel capable of implementing in their different approaches are needed to improve practice at the University of Reading
own lives. Thus the coaching process is ultimately a adherence depending on the patient's type of Download a CPD log sheet that helps you
means of creating a concordant partnership non-adherence. complete your CPD entry when you
between the patient and the pharmacist. See table Helping patients with adherence is not a successfully complete the 5 Minute Test for
1, below, for the model's coaching questions. straightforward task. Although a plethora of this Update article online (p17).

Table 1 Suggested : Case study: non-adherence in Discussion

coaching questions 4 an older patient with asthma At first sight Alma appears to have no
Alma is a grandmother in her late 60s. She is a motivational problems or lack of knowledge
Reactions from others highly proactive person who volunteers for a about medicines. However, she does have a
If your doctor were here now, what would charity and looks after her two grandchildren. misunderstanding about the impact of missed
he think about your condition and your She is referred to the pharmacist by her GP for doses 'now and again'.

treatment? her deteriorating asthma and suspected non- Once Alma understood the importance of not
Would he be satisfied? adherence. She is prescribed a salbutamol and a missing doses, she faced a behavioural problem,
What would he think should be done? beclomethasone inhaler. namely the need to have access to her
If we asked your family/network, what Alma seems motivated, knows the medication when she was away. Alma would
would they say? importance of taking her medication and have been asked coaching questions by the
Are they worried about your condition? considers herself adherent, but forgets to use pharmacist to pick up on her own version of the
© Do they have wishes or suggestions that her steroid inhaler when her routine is story, as well as questions that made her step
you often hear? interrupted by her grandchildren's schedule. into the role of others - what would her
The pharmacist believes Alma's patient daughter want her to do and what would her
Weighing pros and cons medication record indicates under-use. Alma grandchildren want to see?
How do the 'errors' you make today says she uses her inhaler as planned but says The coaching questions would have also
benefit you? "of course slips and lapses happen when your identified Alma's willingness to take control of

What are the disadvantages? attention is elsewhere, but is there really much monitoring her peak expiratory flow rate. So in

On a scale from 0-10, how do you rate the harm in Alma believes
missing a few doses?" summary, rather than a simplistic model, the

importance of, for example, improving your that these lapses could not really make a patient has been listened to in order to find the
peak expiratory flow rate? difference, but also knows that her wheezing has right tools for her individual case.

continued and that her peak expiratory flow rate

In the best of all worlds... has deteriorated, which she found worrying. Things to consider
What will the drug treatment of your, eg The pharmacist conducts an MUR with Alma If Alma represents a patient you might not
asthma, be like in five years? In six months? and talks how she can remember to take
about necessarily hold in high regard, would you think
What would be the most important change her medicines when she is busy, explaining the about your own mannerism when dealing with
needed to make things go that well? consequences of missed doses. Alma says she her? Remember, warmth and empathy can go a
What would be the smallest change needed often forgets to use her inhaler when she is long way.
to make things move forward? called to stay over at her daughter's house to Would you consider making plans for Alma
look after the grandchildren. Although she is not to return so that you can continue the
Noticing success interested in anything too complicated, she is partnership?
Who would notice if you were taking a drug willing to listen and agree to something she How about screening for potential adverse
therapy that you were happy about? How? might be able to try. The pharmacist and Alma effects? Would you provide her with some
What would they see you doing? agree to try two beclomethasone inhalers, so advice about how to avoid them?
that Alma can have one to carry in her bag. The Would you ask Alma to demonstrate her
Seeing possible goals pharmacist also suggests that Alma is given a inhaler technique to make sure she does in fact
Based on our talk, what would you suggest peak flow meter to monitor her own peak have the ability to take her beclomethasone
we do to get the best possible outcome? expiratory flow rate for recording on a chart. correctly?

Assessing options; what would happen if...

We had your doctor change your medicine?

We sent you an SMS every day?
You had your medicine dispensed in a dose
administration aid? NEXT WEEK
I gave you more information about your The first of a two-part series
illness and your medicine?
looks at the management of
You came here to the pharmacy to have
your, eg asthma, monitored? multiple sclerosis

16 Chemist -Druggis I 1 1 .09.1

 -

To get C+D's CPD articles sent to you free, sign up at

www.chemistanddruggist.co.uk/register

Medicines adherence

What are the main factors affecting medicines

adherence? What techniques can pharmacists use to
impact on patient behaviour 7 minute test 1
This article discusses medicines adherence and the role
What have you learned?
pharmacists can have in its improvement. It describes Test yourself in three easy steps:
the factors affecting adherence and techniques for "

communicating with patients. There are coaching Step 1

inn
questions pharmacists could ask as well as a case study.

• Find out more information about medicines

——'
Register for Update 2010 and receive a unique PIN number

adherence, involving patients in decisions about

Access the 5 Minute Test questions on the C+D website at
prescribed medicines and supporting adherence by
www.chemistanddruggist.co.uk/mycpd
reading the Nice quick reference guide at
http://tinyurl.com/35uydqc.
Step 3
• Revise your knowledge of medicines adherence on Use your PIN to complete the assessment online. Your test score will be
the National Prescribing Centre website at recorded.If you successfully complete the 5 Minute Test online, you will

http://www.npci.org.uk/lift/lift.php, which includes be able to download a CPD log sheet that helps you complete your CPD
information, quizzes and case studies. entryatuptodate.org.uk V-'-HV" vi^V/'

Think about how you can use the information in this

article during MURs and when counselling patients Registering for Update 2010 costs £37.60 (inc VAT) and can be done easily
starting new medication. How could you identify non- at www.chemistanddruggist.co.uk/update or by calling 0207 921 8425.
adherent patients in your pharmacy?
Signing up also ensures that C+D's weekly Update article is delivered
directly to your inbox free every week with C+D's email newsletter.
Are you now confident in your knowledge of medicines
adherence? Could you use your skills to find out why a Get a CPD log sheet for your portfolio when you successfully complete
patient was non-compliant and help them improve their the 5 Minute Test online.
adherence?

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 -

CLINICAL

tacrolimus
ADVAGRAF
tacrolimus prolonged release
Practical Approach

What is my
Presentations: Advagraf Prolonged -release hard capsules containing risk factors for these conditions include pre-existing heart disease,

3mg and mg

son's
tacrolimus 5 mg, 1 mg, 5 Program hard capsules corticosteroid usage, hypertension, renal or hepatic dysfunction,

containing tacrolimus 0.5 mg, 1 mg and 5 mg Indications: Advagraf infections, fluid overioad, and oedema. Patients are at increased nsk of

and Prograf: Prophylaxis ot transplant rejection in adult liver or kidney all opportunistic infections including BK Virus associated nephropathy

allograft recipients and treatment ot allograft rejection resistant to and JC Virus associated progressive multifocal leukoencephalopathy
treatment wrth other immunosuppressive medicinal products Posology Physicians should consider this in their differential diagnosis in

spreading rash? and Administration: Advagraf and Prograf therapy

monitoring by adequately qualified and equipped personnel Either drug

should only be prescribed, and changes in immunosuppressive therapy

require careful immunosuppressed
neurological symptoms
posterior reversible encephalopathy
patients

Patients
with

have
deteriorating

been
syndrome (PRES).
renal

reported

It
function

to develop

so radiological
or

initiated, by physicians experienced in immunosuppressive therapy and tests should be performed. If PRES is diagnosed, adequate blood
and how effective are they the management ot transplant patients Dosage recommendations pressure and seizure control and immediate discontinuation of

given below should be used as a guideline Advagraf or Prograf are tacrolimus advised Echocardiography or ECG monitoring pre-and
considered to be? routinely administered in conjunction with other immunosuppressive post -transplant
is

is advised in high-risk patients, and dose reduction of

3. What prescription treatments agents in the initial post-operative period The dose may vary depending and or a change of immunosuppressive agent should be considered if

on the immunosuppressive regimen chosen Dosing should be based on abnormalities develop Tacrolimus may prolong the OT interval Exercise
are used for this condition? clinical assessments of rejection and tolerability aided by blood level caution in patients with diagnosed or suspected Congenital Long QT

4. What other therapies are monitoring. To suppress graft rejection immunosuppression must be

maintained so no the duration ol oral therapy can be given The

Syndrome EBV-associaled lymphoprohterative disorders have been

Concomitant use
limit to reported ot other immunosuppressives such as
used? daily dose of Advagraf capsules should be taken once daily in the antilymphocytic antibodies increases the risk of EBV-associated

morning with water at least 1 hour before or 2-3 hours after a meal. lymphoprolrferative disorders. EBV-VCA negative patients have been

Prograf capsules should be taken as for Advagraf in two divided doses reported to have increased risk ot lymphDproliferabve disorders. EBV-

Advagraf In stable patients converted from Prograf (twice daily) to VCA serology should be ascertained before starting tacrolimus

Advagraf (once daily) on a 11 (mgmg) total daily dose basis the treatment During treatment, careful monitoring with EBV-PCR is

1. Seborrhoeic dermatitis. The cause systemic exposure to tacrolimus for Advagraf was approximately 10% recommended Exposure to sunlight and UV light should be limited. The

lower than for Prograf The relationship between tacrolimus trough secondary cancer unknown Dose may be necessary
is unknown, but it is thought to be risk of is reduction

levels (Cw) and systemic exposure (AUC„ : ,)

tor Advagrat is similar to in patients with severe liver impairment The printing ink used to mark
an inflammatory reaction to a yeast, thai of Prograt. When converting from Prograf capsules to Advagrat Advagraf capsules contains soya lecithin. In patients who are

trough levels should be measured before and within two weeks after hypersensitive to peanut or soya, the nsk and seventy of hypersensitivity
Malassezia furfur. This may be a conversion In de novo kidney and liver transplant patients AUC,,., of should be weighted against the benefit of using Advagraf capsules

normal commensal, but tacrolimus for Advagraf on Day was 30% and 50% lower respectively, contain lactose Interactions: See SPC Pregnancy and lactation:
skin 1

when compared with that for Prograf at equivalent doses. By Day 4, Tacrolimus can be considered in pregnant women when there is no
patients with the condition may systemic exposure as measured by trough levels is similar for both safer alternative See SPC Undesirable effects: Medication errors have
kidney and liver transplant patients with both formulations Race: In been observed A number ot associated cases of transplant rejection
have reduced resistance to it.
comparison to Caucasians, Afro-Caribbean patients may require higher have been reported (frequency cannot be estimated from the available

2. Ketoconazole 2 per cent shampoo. tacrolimus doses to achieve similar trough levels Prophylaxis of data) Many of the following adverse drug reactions are reversible and/

transplant [election - liver and kidney Initial dose of Advagraf and or respond to dose reduction. Very Common (>1/10): Hyperglycaemic
Several studies have validated its Prograf capsules is 10-0 20 mg/kg/day for liver transplantation and conditions, diabetes mellitus, hyperkalemia, insomnia, tremor,

A woman comes into the Update efficacy for dandruff and seborrhoeic 20-0 30 mg/kg/day for kidney transplantation starting approximately headache, hypertension, diarrhoea, nausea, renal impairment,

12-18 hours for Advagraf and 1 2hrs tor Prograf after completion of liver infections, liver function test abnormal, Common (>1/10Q to <1/10):

Pharmacy trailing a reluctant dermatitis of the scalp. or within 24 hours of completion of kidney transplant surgery. Dose haematological abnormalities, hypomagnesaemia, hypophosphataemia,

adjustment post -transplant Advagraf and Prograt doses are usually hypokalemia, hypocalcaemia, hyponatremia, fluid overload,
young teenage boy behind her. She '
Pyrithione zinc. Available mainly reduced in the post-transplant period It is possible in some cases to hyperuncaemia, appetite decreased, anorexia, metabolic acidoses,

asks to speak to the pharmacist, as 'medicated' shampoos that are withdraw concomitant immunosuppressive therapy leading to Advagraf hyperlipidaemia, hypercholesterolemia, hypertngiycendaemia, anxiety

monotherapy or Prograf dual therapy or monotherapy Post -transplant symptoms, mental disorders, confusion and disorientation, depression,

David Spencer. not licensed as medicines. It has improvement in the condition of the patient may alter the mood disorders and disturbances, nightmare, hallucination, seizures,

pharmacokinetics tacrolimus and may necessitate further dose disturbances consciousness, paresthesias and dysaesthesias,
"I wanted to take Kevin to the produced inferior results to
ot in

adjustments Dose recommendations - Conversion to Advagraf, Patients peripheral neuropathies, dizziness, wnhng impaired, vision blurred,

doctor," the woman says when ketoconazole. maintained on twice daily Prograf requiring conversion to once daily photophobia, eye disorders, tinnitus, ischaemic coronary artery

Advagraf should be converted on a 1:1 (mg:mg) total daily dose basis. disorders, tachycardia, haemorrhage, thromboembolic and ischaemic
David comes out to see her. "He e Selenium sulphide shampoo. It
Following conversion, tacrolimus trough levels should be monitored and events, vascular hypotensive disorders, peripheral vascular disorders,

refused to go but managed to

I is as effective as ketoconazole, but if necessary dose adiustments made Care should be taken when dyspnoea, parenchymal lung disorders, pleural effusion, pharyngitis,

converting patients trom ciclosponn-based to tacrohmus-based therapy. cough, nasal congestion and inflammations, gastrointestinal

persuade him to come here." less well tolerated and less pleasant Initiate Advagraf after considering ciclosponn blood concentrations and inflammatory conditions, gastrointestinal ulceration and perforation,

clinical condition of patient Delay dosing in presence of elevated gastrointestinal haemorrhages, stomatitis, ascites, vomiting,
"What's the problem, Kevin?" to use.
ciclosponn blood levels Monitor ciclosponn blood levels following gastrointestinal and abdominal pains, constipation, flatulence, bloating

David asks, turning to the boy. Coal tar. This has been shown to conversion Dose recomm endations- Rejection therapy For conversion and distension, loose stools, bile duct disorders, hepatic enzymes and
of kidney and liver recipients from other immunosuppressants to once function abnormalities, cholestasis and jaundice, hepatocellular damage
"Nothing much, just dandruff," be significantly more effective than daily Advagraf, begin with the respective initial dose recommended for and hepatitis, cholangitis, pruntus, fash, alopecias, acne, sweating

increased, arthralgia, muscle cramps, limb and back pain, renal failure,
Kevin replies. placebo. It is available as shampoos rejection prophylaxis. In adult heart transplant recipients converted to

Advagraf, an initial oral dose of 1 5 mg/kg/day should be administered oliguria, renal tubular necrosis, nephropathy toxic, bladder and urethral

"It's more than that," his mother and an ointment (which also once daily in the morning For other allografts, see SPC. Dose symptoms, asthenic conditions, febrile disorders, oedema, blood
adjustments in specific populations: See SPC Target whole blood trough alkaline phosphatase increased, weight increased, body temperature
interjects. "It's quite nasty, flaking contains salicylic acid). concentration recommendations: Blood trough levels lor Advagraf perception disturbed, pnmary graft dysfunction Uncommon (>1/1000

And it's spreading down his face - Salicylic acid. It has a keratolytic should be drawn approximately 24 hours post-dosing, just prior to the to < 1/1 00). coagulopathies, coagulation and bleeding analyses

next dose, for Prograf approximately 12 hours post-dosing Frequent abnormal, pancytopenia, hypoproteinaemia, hyperphosphataemia,
look." She points to red scaly effect, but in shampoos it may be trough level monitoring in the first two weeks post-transplant is hypoglycaemia, coma, central nervous system haemorrhages and

recommended, with periodic monitoring during maintenance therapy. cerebrovascular accidents, paralysis and paresis, encephalopathy,
patches around the boy's eyebrows too dilute and have insufficient
Monitoring is also recommended following conversion from Prograf to speech and language disorders, amnesia, cataract, arrhythmias, cardiac

and bridge of his nose. contact time to be effective. Advagraf, dose adjustment, changes in the immunosuppressive arrest, heart failures, cardiomyopathies, infarction, deep venous

regimen, or co-admimstration ot substances which may alter tacrolimus thrombosis, shock, respiratory failures, respiratory tract disorders,
David asks: "Does it hurt or itch, 3. Topical: hydrocortisone and other whole blood concentrations (see 'Warnings and Precautions' and asthma, paralytic ileus, peritonitis, acute and chronic pancreatitis,

Kevin? And why won't you go to steroids (hydrocortisone cream is

'Interactions'), Adjustments to the Advagraf and Prograf dose regimen anuria, haemolytic uraemic syndrome, uterine bleeding, psychotic

may take several days before steady stale is achieved. Most patients disorder, multi-organ failure. Rare l>1/10.000 to<1/1000): thrombotic
the doctor?" available without prescription, alone can be managed successfully if tacrolimus blood concentrations are thrombocytopenic purpura, blindness, neurosensory deafness,

maintained below 20 ng/mL In clinical practice, whole blood trough pericardial effusion, acute respiratory distress syndrome, subileus,
"It itches a bit sometimes. But and in combination with miconazole, levels have been 5-20 ng/mL in liver transplant recipients and pancreatic pseudocyst, hepatic artery thrombosis, venoocclusive liver

it's nothing much, it'll probably just which has been found effective for 10-20 ng/mL in kidney transplant recipients early post-transplant, and disease, toxic epidermal necrolysis (Lyell's syndrome). Very rare

5-15 ng/mL during maintenance therapy Contraindications: (<1/10.00Q including isolated reports!: hepatic failure, Stevens Johnson
go away soon. It's not worth seborrhoeic dermatitis, but licensing Hypersensitivity to tacrolimus or other macrolides or any excipient. syndrome, nephropathy, cystitis haemorrhagic, Neoplasms. Con sult ff|e

Warnings and Precautions: Medication errors, including inadvertent, SPC complete information on side effects and prescribing
hanging around in the doctor's," conditions prohibit use on the face); for full

unintentional or unsupervised substitution of immediate or prolonged- information. Package Quantities, Basic NHS cost & Product licence
Kevin replies. metronidazole gel, tacrolimus release tacrolimus lormulations, have been observed. This has led to numbers: Advagraf/Prograf: 0.5 mg capsules x 50 = £35.79
serious adverse events, including graft rejection, or other side effects (EU/1/07/387/002)/£61.88 (PL 00166/0206). respectively. 1 mg
The mother interrupts again: ointment. which could be a consequence of either under- or over-exposure to capsules X 50 = £71.59 (EU/1/07/387/004)/£80.28 (PL 00166/0203),

"Mr Spencer, do you know what it • Systemic: oral antifungals tacrolimus Patients should be maintained on a single formulation ot respectively. 1 mg capsules x 100 = £143 17 (EU/1/07/387/006)/£160.54

tacrolimus with the corresponding daily dosing regimen; alterations in (PL 00166/0203), respectively. 5 mg capsules x 50 = £266.92
is, and do you have anything to get terbinafine, fluconazole, formulation or regimen should only take place under the close (EU/1/07/387/008)/£296.58 (PL 00166/0204), respectively. Advagraf

supervision of a transplant specialist Advagrat only limited experience 3 mg capsules x 50 = £214 76 (EU/1/07/387/01 2). Legal Classification:
rid of it?" itraconazole, ketoconazole.
in non-Caucasian patients and those at elevated immunological risk. POM Date ol Revision: May 2010. Further information available from

"Well, Mrs Evans," David replies, 4. Phototherapy: UV light. Patients Advagraf is not recommended for use in children below 18 years due to Astellas Pharma Ltd, Lovert House, Lovett Road, Staines TW18 3AZ.

limited data on safety and efficacy Advagraf and Prograf: During initial Advagraf and Prograf are registered trade marks. For medical
"I think I know what it is and there often experience improvement period routinely monitor blood pressure, ECG, neurological and visual Information phone 0800 783 5018

are several things available without during the summer, and treatment status, fasting blood glucose, electrolytes (particularly potassium), liver

and renal function tests, haematology parameters, coagulation values,

a prescription that could clear it up. with UVB has proven successful. and plasma protein determinations, consider adjusting the Adverse events should be reported.
immunosuppressive regimen clinically relevant changes are seen Reporting forms and information can be found at
But Kevin, I have to warn you that if Psoralen plus UVA (PUVA) is also
if

Herbal preparations, including those containing St John's Wort, should

www.yellowcard.gov.uk.
they don't work or it gets any used. be avoided Extra monitoring of tacrolimus concentrations is
Adverse events should also be reported to
recommended during episodes of diarrhoea. Avoid concomitant
worse, you will have to go to the References are at www.chemist Astellas Pharma Ltd - 0800 783 5018
administration of ciclosponn Ventricular hypertrophy or hypertrophy of

the septum (reported as cardiomyopathy) have been seen rarely, other

doctor." anddruggist.co.uk/practicalapproach

Oiiestio'fis
For more Practical Approach
1. What is Kevin likely to be
scenarios, go to www.chemist '
NHS Blood and Transplant, August 2009. NHS Transplant
suffering and what is the cause?
anddruggist.co.uk/practical Activity in the UK, 2008-2009.
2. What treatments are approach
t www kidney.org.uk June 2010.
astellas
available without prescription. Job code PRG10028UK Date of preparation June 2010 Leading Lighi for Life

18 Chemist+Druggist 11.09.10
I was one of 1190 people waiting for a kidney*

5 years waiting
12 hours of dialysis a week'

180 hospital visits

1 car crash 3 families affected
2 ambulances 3 doctors 4 nurses
1 specialist transplant team
nrnnnmnJI l life-changing gift
1 personalised drug regimeo

Now it's up to you

Tacrolimus. Be specific.
Always use the brand name

raf
tacrolimus

» ADVAGRAF
tacrolimus prolonged release

astellas
Leading Light for Life

Prescribing information can be found on the adjacent page

JOb code PBG10O28UK date of oreparabon June 2010
 .

ZONE 15 Med icines adherence ^ 18 Seborrhoeic dermatitis 20 Sutherland's Pharmacy ;

23 Neuropathic pain

Design

lUTA

Contractor Torquil Clyde

focused on incorporating
customer service into the
award-winning design of
pharmacy on Orkney.
his

Hannah Flynn reports

Design
The pharmacy
factfile Design
Sutherland's Pharmacy, Kirkwall, Orkney
With shop
its two entrances and roomy
floor, the first thing that hits
site and then transported
over a seven-day period.
it to Orkney to be fitted

The contractor you at Sutherland's Pharmacy in

Torquil Clyde Kirkwall, Orkney, is the space - unexpected to an 'Drive-through' pharmacy

outsider on such a small island. One of the main challenges experienced at the
The challenge A redesign of the remote pharmacy, which previous Kirkwall site was the narrowness of the
Completing a redesign in a remote, island took second place at this year's C+D Platinum streets. The historic lane the pharmacy is on offers
location Design Awards in association with Ceuta little space for cars or delivery vans to park.
Healthcare, took place after it moved premises Customers had highlighted this issue in a survey
along the same road. the pharmacy carried out before deciding to move
Relocation including car access, electric doors, Pharmacist Torquil Clyde's Sutherland's the shop.
better integration of retail and dispensary Pharmacy business is a mainly offshore one (it has Mr Clyde says: "One of our objectives was to
space, more efficient dispensing and easy several other branches, including in mainland have another entrance that people could drive to
integration of new Scottish contract services Scotland), and the prospect of completing a but also one delivery drivers could use. So that is a
redesign at such a remote location does not big advantage of the site.

appear to have phased him. "The only difference "We were very keen to have electric doors as
£428,000, including robot was the cost of importing the supplies," he says. there is a lot of evidence there is better customer
The prize-winning shop was designed by flow with electric doors and it helps people
Anderson Retail Consultants, after Mr Clyde saw with prams, wheelchairs and buggies, and things
Second place, C+D Platinum Design Awards the work they had done for a previous Platinum like that."

2010, and a cheque for £2,000 Design Awards winner. According to Mr Clyde, The rear car park contains a buzzer that
they manufactured the entire shop interior off- disabled customers can use to alert staff when

ESSENT,AL L ,NKU
PGRAOe .

NATIONAL PROGRAM
 nam*

The visually stunning Sutherland's Pharmacy

in Kirkwall, Orkney, was designed with the
new Scottish contract in mind and combines

n Orkney the tills and the PMR in

access to patient information. Contractor

Torquil Clyde
Platinum Design Award
is pictured far
one system to simplify

left, with his

they arrive. They can also speak to staff in the quickly as possible and more are now on the shop He also feels the customers benefit from the
dispensary via the system. floor, he says. greater amount of interaction with the staff they
"We did this for disabled access, and to show "It is more like the European style and saves a now have because of the introduction of the
we were thinking about all of our customers," Mr lot of staff time so you don't have two staff out dispensing robot.
Clyde says. the back doing prescriptions and then staff out He says: "It is more direct. We are speaking
"I guess you could call it a 'drive-through' front doing the serving directly to the customers and this feels better and
pharmacy as they can press the button and we "When someone comes in with an acute script more natural doing that. There is no 'please tell

can come and serve them." we literally scan it, the robot finds it instantly and Mrs Jones to take her tablets at night'. No, you just
He adds it is also used by parents with ill by the time you have done the label the [product] tell her yourself, so that is a definite advantage."
children who don't want to leave them in the car is there and you can serve somebody in under one
while they get prescriptions, so staff will also minute. It is almost too quick! Sometimes you Design for the future
leliver medicines to them in the car park. want people to go away and shop. It is extremely Aware the chronic medication service (CMS) was
quick for walk-in scripts." soon to be introduced in Scotland, Mr
European-style dispensing
In the shop itself he had further plans to radically
overhaul the way the staff did business. One Watch our interview with contractor Torquil Clyde
objective was to integrate pharmacy and retail
and hear more about how his award-winning
staff and make the whole dispensary more

customer-facing. Mr Clyde also wanted to make design was planned and executed on Orkney
the dispensing process more efficient.
The introduction of the dispensing robot has www.chemistanddruggist.co.uk
allowed staff to focus on serving customers as

From the moment your pharmacy is connected to our enhanced, intuitive PMR system with its future-proof design, you

are connected to a better future. So, with the demands being made on you by the current National Programmes, get better

connected today. Call your ProScript LINK Account Manager, email proscriptlink@aah.co.uk or visit www.aah.co.uk.

ADY'
C
0NNECTINGY0Ul0^™»«fPrO LINK ONLY FROM
AAH
 CLINICAL CLINICAL

15 Medicines adherence 18 Seborrhoeic dermatitis 20 Sutherland's Pharmacy 23 Neuropathic pain

Sutherland's staff say:

The robot has made it possible to serve some customers in less than a minute, says Torquil Clyde

Clyde was keen the design would facilitate easy "Having our computers, which are Positive
incorporation of services. The pharmacy has Solution computers, we find having the tills and
several large consultation rooms but has also the PMR as one system means you can swap
incorporated plans into the pharmacy's high-tech easily between one or the other and see a
computer systems, which can switch between the customer's complete information,
tills and PMR depending on who is using them "We also use loyalty cards quite a lot and if

Mr Clyde says: "Thinking about Scotland in someone buys a P medicine on their loyalty card
particular, with CMS coming, it is going to be so then it automatically goes onto their PMR record
much easier for us than some pharmacists as we for review."
are dealing directly with our customers. Customers have responded well to the changes,
he adds. Many have reported how much easier it

CPD Reflect • Plan • Act • Evaluate is to find products and are pleased the shop is so
close to the old site and near the health centre
Tips for your CPD entry on pharmacy design
Qne regular customeri E[eanor McBeathi says

REFLECT Does my pharmacy present a she en J°y s the customer service the pharmacy

professional image and support offers and feels offers a lot of extra services that

other Pharmacies don't.

work processes?
She says: "It is easier to find things now, before
PLAN Consider how a refit or smaller
was wry cramped haye defjnite[y seep [qX
jt , fl

layout changes could improve

more customers since the redesign. It is a lot
image and work processes busier in here now."
ACT Implement refit or layout changes Mr Clyde is pleased with the results of the
desi § n he ho P es t0 roU out the chan § es
and said
EVALUATE Have public image and workflow
he has made
to his other shops,
v including°
another
improved?
offshore site on Shetland.

Accountant Richard Baker explains the tax issues to

bear in mind when considering fit-outs and refits
When undertaking a fit-out or refit project, one 20 per cent and 10 per cent per annum
thing that often gets missed is the tax aspect. respectively for tax purposes.
You may think that spending money on this In 2008, the government introduced an
legitimate business expense will automatically Annual Investment Allowance. From April 1 this

qualify for tax relief. Generally that is the case, year, the first £100,000 of capital expenditure in
but it is the timing of the tax relief that can vary any year (as long as it qualifies for capital

considerably. allowances) will qualify for immediate tax relief.

Expenditure on these projects falls into a If you are spending more than this, it can be
number of categories. It may: allocated to integral features first to accelerate
• qualify for capital allowances (which is the the tax relief.

taxman's version of depreciation) A further point to consider is expenditure on

• qualify as an expense, mainly where refits are 'energy-saving equipment'. This qualifies for
concerned, which is tax deductible in the year of immediate tax relief. Energy-saving equipment
the spend could include air conditioning systems,
qualify for tax relief when the asset (often the refrigeration equipment and lighting. A full list is

related property) is eventually sold available of qualifying products.

• never qualify for any tax relief (for example, Finally, you can help your accountant to save
improvements to a leasehold property which do you tax by gathering as much information as
not qualify for capital allowances or as a tax- possible on the cost of the refit or fit-out, so that Next month: Platinum Design Awards 2010
deductible expense). the expenditure can be correctly classified. and Best Multiple Pharmacy
first prize
Expenditure that qualifies for capital Richard Baker is a partner at accountancy winner Murrays Healthcare, Malvern
allowances is categorised into 'plant and firmHorwath Clark Whitehill and C+D's
machinery' and 'integral features'. Finance Zone columnist • PLUS Your guide to legal considerations
This expenditure is then written down at www.chemistanddruggist.co.uk/finance for fit-outs and refits

22 Chemist+Dru ist 11.09.10

 CLINICAL CLINICAL BUSINESS CLINICAL

4 15 Medicines adherence 4 18 Seborrhoeic dermatitis 4 20 Sutherland's Pharmacy V 23 Neuropathic pain

10 THINGS YOU NEED TO KNOW ABOUT...

Neuropathic pain
Following the publication of Nice guidelines on the pharmacological management
of neuropathic pain, Gavin Atkin explains what you need to know

Neuropathic pain arises from damaged or dysfunctional nerves, and In patients where the source of pain is not associated with diabetes,
can be due to a range of disorders affecting the peripheral and central the first-line treatments are oral amitriptyline starting at lOmg/day
nervous systems, including diabetic neuropathy, post-herpetic gradually titrated upward to the maximum tolerated dose up to
neuralgia and trigeminal neuralgia.
75mg/day, or pregabalin starting 150mg/day (or less in some
at
patients) in two daily doses with upward titration to the patient's
People with neuropathic pain may experience altered pain sensation, maximum tolerated dose of no higher than 600mg/day. If satisfactory
areas of numbness and continuous or intermittent evoked
or burning, pain reduction not achieved with
is first-line treatment at the maximum
or spontaneous pain. Neuropathic pain is an unpleasant sensory and tolerated dose, the patient should be referred to a pain clinic or offered
emotional experience that can have a significant impact on a person's another drug in addition or as an alternative to their first-line treatment.
quality of life.
The third-line options are oral tramadol and topical lidocaine.

Neuropathic pain remains difficult to treat because it is resistant to In patients whose pain is due to diabetic neuropathy, oral duloxetine
many medications and the effective treatments have adverse effects. should be offered as a first-line treatment, starting at 60mg/day (less
in some patients). Where duloxetine is contraindicated, amitryptyline
Patients should be referred to a specialist pain clinic or disease-specific
should be offered.
specialist at any stage if their pain is severe or limits daily activities, or
their underlying health deteriorates
If amitryptyline proves effective but the
patient is unable to tolerate its
adverse effects, oral imipramine or nortriptyline should be considered.
Patients' concerns and expectations should be addressed when
Reference: Neuropathic pain - pharmacological management,
agreeing which treatments to use, and these are likely to include the
http://guidance.nice.org.uk/CG96
benefits and possible adverse effects of pharmacological treatment,
coping strategies for dealing with pain and the adverse effects of
CPD Reflect • Plan • Act • Evaluate
drugs, and non-pharmacological treatments including surgery and
psychological therapies. Tips for your CPD entry on neuropathic pain management

The selection of treatments should take comorbidities, safety issues REFLECT Do understand current guidance on
I
the pharmacological
and contraindications into account, as well as mental health problems. management of neuropathic pain?
The titration process must be explained, and when withdrawing or
PLAN Assess which aspects of neuropathic pain management you
switching treatment, doses should be tapered. Clinicians should are least clear about
consider overlapping treatments to maintain the pain control. ACT Read this article and the relevant secti ons of the Nice
guidance (see reference above)
Patients should be reviewed shortly after a change in treatment to
EVALUATE Can I advise GPs and patients on drug treatment for
ensure it is suitable, and should be reviewed regularly.
neuropathic pain?

1 1.09.10 51 23
 1

ence r FREE
[ REGISTER
{ TODAY
^ See below
for details .

Sunday, October 10 Monday, October 1

:
10.20am
The five biggest challenges facing pharmacy and what the Society The new white paper - where next for NHS services?
will do to help you Alan Milburn, former secretary of state for health.
Helen Gordon, chief executive, the RPS The government's vision for primary care will see GPs charged with
As the RPSCB returns to its roots as the leadership body for commissioning local services as PCTs are consigned to the scrap heap.
pharmacists, its new chief executive reveals how the Society will steer Alan Milburn examines whether the new NHS blueprint will change the
pharmacists to a more rewarding professional future NHS landscape for better or for worse

11.00am
How your change under the new pharmacy regulator
life will A multiple's view of the new look NHS
Duncan Rudkin, chief executive, General Pharmaceutical Council Andy Murdock, director of pharmacy, Lloydspharmacy
Pharmacists have a new professional regulator but will it just lead to Following the white paper theme, Lloydspharmacy's Andy Murdock
tougher sanctions or will the promise of 'light become
touch' regulation identifies the opportunities and threats that pharmacy faces under the
a reality? The CPhC's Duncan Rudkin reveals what the profession's new latest NHS revolution
disciplinarian will mean for you

1.50pm What the new dawn in pharmaceutical wholesaling means at the

The inside track on stat comms and what pharmacists have to do to coal face
ensure they get a fair hearing Mark James, managing director, AAH
David Reissner, head of healthcare, Charles Russell solicitors Quotas, DTP, discounts and parallel trading - the supply chain is the
With community pharmacy now facing more scrutiny than ever one topic that affects every pharmacist. Mark James cuts through the
before, David Reissner looks at the common reasons pharmacists get crossfire and looks for a workable solution
prosecuted and offers tips on what you should do if an inspector calls

12.20pm
Generics, the NHS, and you
Pharmacy contract funding - a behind-the-scenes account of where Michael Cann, chairman, BGMA
we are and what the future holds Love 'em or hate 'em, generics play a major part in keeping the NHS
Sue Sharpe, chief executive, PSNC drugs bill down. Michael Cann looks at the opportunities that generics

PSNC chief executive Sue Sharpe explains what's happening in the provide for pharmacists including category M and generic substitution
latest round of contract funding negotiations and what the future NHS
Commissioning Body will mean for your funding
How ditching toiletries and cosmetics helped boost our healthcare
3.15pm business
The C+D Senate Live in association Kenny Black, managing director, Rowlands Pharmacy
with Actavis Rowlands Pharmacy has piloted a new front of shop business model
C + D's pharmacy think-tank holds its which has seen toiletries and cosmetics replaced with a greater focus

nun first ever live event. An expert panel

will discuss the big issues impacting

on grassroots pharmacy practice and
on healthcare. Kenny Black explains why pharmacy must change and
shares top tips from the Rowlands experience

THE C+D SENATE will field questions from the audience. 1.40pm
IN ASSOCIATION
How to press your PCT's buttons when it comes to local
j_
with "actavis Don't miss this unique chance to be commissioning
part of the debate. Julie Wood, director, clinical commissioning, NHS Alliance
Panellists include: Ian Facer, Rob There's no escaping the 'c' word - it's a fact that commissioning is going
Darracott, Sue Sharpe, Michael Cann to be a big part of pharmacy's future. Julie Wood offers her tips on what
and David Reissner you need to do to get services commissioned

2.20pm
An examination of Co-op's blueprint for pharmacy
Chris Brooker, business development director. The Co-op Pharmacy
Every session will include an audience Q+A The Co-operative Pharmacy is one of the fastest growing multiple
PLUS interactive voting technology chains. Chris Brooker shares the company's blueprint for pharmacy and
offers his tips on maximising your business

SIGN UP FOR YOUR FREE TICKETTODAY AT

www. chemistanddruggist.co.uk/thepharmacyshow
 Hundreds more jobs online
www.chemistanddruggistjobs.co.uk

0207 921 8123

Booking and copy date Contact: Andrew Walker ChemisUDruggist
12 noon Monday prior Tel:0207 921 8123 Ludgate House
to Saturday publication Fax: 0207 921 8132 245 Blackfriars Road
subject to availability andrew.walker@ubm.com London SE1 9UY

University of

ULSTER "I find rewarding to

it really
be developing pharmacists
SCHOOL OF BIOMEDICAL SCIENCES
of the future."
Technician Grade 5, Pharmacy Practice
Ref 1156723/CD
Salary £21,578 £24.287 Base Colerame
Closing date 24 September 2010 "There's always been a strong commitment
The postholder will be lequired to support the day-to-day operations
to development here. That's why, as well as

related to pharmacy practice within the Department of Pharmacy and

getting to know my new customers, I've also

Phaimaceutical Sciences been passing on my own experience and

knowledge to our Preregistration Trainee
We prefer to issue and receive applications via our on-line recruitment and Pharmacy Undergraduate Summer
website at www.ulster.ac.uk jobs Placement Student."

Hard copy applications can be obtained by telephoning 028 701 2 3456 Find out more from Jina and about
The University is an equal opportunities employer and welcomes applicants from all becoming a Pharmacist or Pharmacist
sections of the community, particularly from those with disabilities Appointment will be
Store Manager by visiting
made on merit
www.boots.jobs/pharmacy

SALES MANAGER feel good

Pharmaceutical/Healthcare *7

Package negotiable London (South)

An established and leading niche pharmaceutical and
healthcare products company is looking for an experienced
OXFORDSHIRE
professional to head up a new marketing department and take
Enthusiastic Pharmacist required to manage and provide the
responsibility for sales and a small sales team.
full range of services in our established and well supported
branch in Abingdon.
The successful candidate will, in addition to possessing skills in
Excellent Salary
consumer marketing, be an innovator in his or her approach
Send your CV by email: satnam.buttcr@lpcphQrmQ.com
to new product launches, design and consumer and trade or coll on 01 582 560393 No agencies please.
advertising and promotion. Although not absolutely essential,

you have probably worked in the industry and have a good Eynsham, Grove Wantage & Swindon
knowledge of retail pharmacy and pharmaceutical wholesaling. Bicester OXFORDSHIRE
Relief & Pharmacy
As this is a new position we are looking for an individual who Currently recruiting Managers required
understands the inextricable relationship between sales and Relief & Pharmacy
{negotiable + excellent
marketing and has excellent communication skills to develop Managers
benefits
the role both internally and externally.
{negotiable + excellent benefits
Please call Maria McElvenney on
In return, the Company is offering a comprehensive package Please call Maria McElvenney on 02476 432983 and email your CV co
02476 432983 and email your CV to maria.mcelvenney "alloydspharmacy.co.uk
with the great potential to grow with this exciting business.
maria.mcelvenney@lloydspharmacy.co.uk

Please send full details/CV to:

P. O. Box No: 8 23, Chemist and Druggist,

1

Lloydspharmacy (^) Lloyds

Ludgate House, 245 Blackfriars Road, London SEI 9UY Healthcare lor life Hea'thcare for life

11.09.10 25
 Meet the C+D Jobs team at the 2010 Pharmacy Show
Register for your free ticket at www.chemistanddruggist.co.uk/thepharmacyshow (^^j

North Devon Princes Risborough, Buckinghamshire Pharmacy Manager - Shropshire Border

Pharmacy
Relief Pharmacist & Pharmacy manager or long term locum
Managers required Pharmacy Manager required for village pharmacy.
For our established community
Negotiable, flexible contracts *
Short working week of ONLY 32 hours, but can be
branch & new 'Premium' store flexible.
+ excellent benefits *
No week-ends. Half day Wednesday.
{negotiable + excellent benefits
Please call Maria McElvenney on *
No MUR's. No pointless paper-work.
02476 432983 and email your CV to
Please call Maria McElvenney on
02476 432983 and email your CV to
* Excellent salary package offered to right candidate.
maria.mcelvenney@lloydspharmacy.co.uk
maria.mcelvenney@lloydspharmacy.co.uk *
Five weeks per year or more by negotiation.

Contact Adrian Edwards on 01624 837893

Lloydspharmacy (@) Lloydspharmacy Qj^)
Healthcare for life Healthcare for life
or e-mail adrian edwards(a)manx.net

Dispensing Assistant/Technician Bishopsworth & Whitchurch,

Required - Part or Full Time Bristol

Working towards or qualified to Pharmacists required

NVQ level 2 or 3. the ideal
candidate will have the right Negotiable + excellent
experience to carry out a benefits
supervisory role in our new
pharmacy located at The Flitwick Please call Maria McElvenney on
Surgery. Flitwick, Bedfordshire. 02476 432983 and email your CV to
maria.mcelvenney@lloydspharmacy.co.uk
The closing date tor this application
is Friday 10th September

For an application form

please email
highlandspharmacv@hotmail.co.iik
Lloydspharmacy @)
Healthcare for life

Foundation Degree (FdSc) in Pharm

m laoi
Birkbeck
UNIVERSITY OF LONDON
I

Practice, Science and Management

Take the first step into your new career
This degree, devised specifically for practicingpharmacy
technician professionals, The School of Pharmacy,
offered by
JJ /)
is
for information on our vacancies contact Katnona on
020 8256 6222 or e-mail careers@daylowisplc.co.uk Birkbeck and Westminster-Kingsway College. These three
day lewis institutions are leaders in London for pharmacy, lifelong learning
WMnv.daytewisplc.co.uk/careers
Pharmacy
and technician training and for this degree are in partnership
with NHS practitioners and managers. Attendance is one
afternoon and the same evening a week during term time.

www.chemistanddruggistjobs.co.uk The foundation degree provides good Continuing Professional

Development (CPD). It allows technicians to develop skills and
confidence in pharmacy practice in primary and secondary care
and the managed care sector.

LOCUM PHARMACIST'S Find out more at our Open Evening from 5.45pm-7.15pm
on Monday 18th October 2010 in Rooms B62/B64
HANDBOOK 2009/10 Main Building, Malet Street, London WC1E 7HX
Your pocket guide to Locum Pharmacy Practice (entrance via Torrington Square).

HAVE YOU EVER CONSIDERED PUBLISHING YOUR OWN REF For further information:
BOOKS FOR ALL YOUR PHARMACIST COLLEAGUES ?? Email: biosciencesfd@bbk.ac.uk
WE CAN HELP !!! Web: http://www.bbk.ac.uk/study/ug/pharmacy/
UFSPHARM.html
UPP PUBLISHING SERVICE....( ARTWORK, PUBLISHING,
COPYRIGHT, DISTRIBUTION)
FOR FURTHER DETAILS, PLEASE CONTACT
The School of Pharmacy
University of London WeVmmsterKingsway
wk
J l * - 1 *t y

NATLOCUM@AOL.COM
i . I

26 Chemist+Druggist 1 1.09.10
 Call 0207 921 8123

0207 921 8123

Contact: Andrew Walker
andrew.walker@ubm.com

valuing and selling

Orridge Business Sales

pharmacies for
over 160 years

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THINKING OF SELLING
YOUR PHARMACY? Think Pharmacy Finance: Think Pharmacy Partners

Come and meet Hutchings Consultants at

THE PHARMACY SHOW PHARMACY
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We are pleased to announce that as the Contact us today:

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We willbe delighted to meet you to discuss the services the legal prescription
we offer and to advise how we can assist you
in the successful sale of your pharmacy. Cost effective specialist legal advice
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For information about our services please visit our website
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Or for a free valuation please call wellas related leases, sales and purchases

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UP Contact

1
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ANSONS Hilary D'Cruz or Jas Singh
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Solicitors www.ansonsllp.com

11.09.10
 Shop fitters? Advertise here every Saturday

CLASSIFIED Call 0207 921 8123

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Pharmacy design and shopfitting
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11.09.10
 Call 0207 921 8123

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As the leading tax consultants
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M modiolus**
CD
Chemist+Druggist remains the clear leader
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I ADDING VALUE

in influencing stock decisions*

i

*Linda Jones Associates Industry Survey 2009

11.09.10 29
 Got a story for Postscript?

postscript@chemistanddruggist.co.uk

New pharmacy role is inflated @The Web Hunter

A pharmacist in Redbridge has gone beyond the Mr Muir says: "It is not practical to stand there
call of duty to get the safe sex message out for his in a condom suit getting people to fill out forms, As I write, this column is somewhere around two
PCT's campaign. which they need to do to get hold of the free days late, but unlike with vital medicines, the only
Jason Muir, manager of Daniels Pharmacy in condoms normally. So we are giving them flyers likely outcome is that I will get earache from
east London, has donned a full body inflatable with information about sexual health services in C+D's production editor.

condom suit and will be handing out free condoms the pharmacy, which have a condom stuck to As our exclusive 2010 Stock Survey reveals,
to 16 to 25-year-olds outside the shop this month. them. People are really responding well." there are some serious issues in the UK medicines
Sponsored by Pasante, which provided the Daniels Pharmacy has the suit for two more supply chain. And as the story gains traction in the
costume, and funded by Redbridge PCT, the stunt weeks, when it will be replaced by a hi-tech wider media, it is interesting to see what aspects
is designed to encourage young people to come glow-in-the-dark condom costume from the of our findings are teased out.
into the pharmacy to take advantage of free manufacturer The Daily Mail uses a combination of our survey
condom and lube packs, free chlamydia screening "The PCT has asked me to go clubbing in the data and a story it ran earlier this year to focus on
and other sexual health services. glow-in-the-dark suit," Mr Muir adds. "It's pretty the trading of drugs into the Eurozone. It says that
It has been timed to coincide with Redbridge hot in that thing. It's sweaty and grim, but it does one in 10 pharmacists, "as well as wholesalers,
PCT's sexual health campaign. appear to be having the desired effect." dispensing doctors and even NHS hospitals - are
making money from an export trade worth an
estimated £360 million a year".
The Scotsman, on the other hand, focuses much
more on how the lack of branded medicines is

"hitting patients hard". The Scottish national

focuses on our statistic that a third of pharmacists
know a patient whose health had suffered as a
result of difficulty sourcing a medicine, and that
the shortage was predicted to get worse next year.
But moving away from how the story has been
covered, it's worth looking at what other
industries would do. In any other retail supply
chain, these sorts of shortages would be
intolerable and could drive retailers out of
business. And in any other supply chain, retailers

would be able to switch suppliers if goods

weren't available.
But pharmacists are being held over a barrel -
there is often only one supplier of a life-saving
drug. And if the drug is in short supply, there is

very little UK pharmacy can do.

So what is the answer? Is there any solution
industry leaders have missed? Do you have a

Jason Muir: suited, booted, pumped up and ready to meet his suggestion that could resolve the stock crisis? Let

Redbridge pharmacy customers me know your thoughts.

Niall Hunt is C+D's digital content editor;
email him at niall.hunt@ubm.com

A social tweet @Squeelaa: I never thought

words "Toxic Mega Colon" but
I would hear the
I just have. It's
From luminous condoms to toxic megacolon, almost made my day. Last week's top stories
join the debate at twitter.com/chemistdruggist

@CandDChris: Toxic Megacolon is a serious

on C+D's website
complication. But yes, it does sounds like a
particularly villainous giant stompy robot. 1. Clinical debate: We can't afford wait in STI war

@VicThompson: Neuropsychopharmacology 2. Oxford pharmacist faces death threats

@CandDHannah: have just spoken to a
I looks like a typo.
pharmacist whose PCT has asked him to go 3. Stock shortages soar as supply chain hits crisis

clubbing in a glow-in-the-dark condom. Respect. @CandDChris: @VicThompson the real problem is I

point, C+D survey finds
when you get into neuropsychopharmacokinetics.
@GaryParagpuri: On my way to BBC's Portland 4. Co-operative Pharmacy profits soar 26 per cent
Place for R4 debate on supply chain problems. @CaryParagpuri: Just been asked to submit my
Spoke to a pharmacist last night and we struggled CPD to the RPSGB. No idea what they'll make of 5. Manufacturer supply deals blamed for drug
to find a solution. my entries or how patients benefit from me. shortages

30 Ch jgeist 11.09.10
 CD obs
The place to find your perfect job
Personalised
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new jobs
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about over for hundreds
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 :

FOSTAIR T
Beclometasone + formoterol

M
FOS- effects of inhaled corticosteroids may occur, particularly at high doses prescribed for cataract, atrial fibrillation, dyspnoea, exacerbation of asthma, growth retardation
(becjoi ionate and formoterol fumarate dihydrate) pressurised long periods. These effects are much less likely to occur with inhaled than with oral in children and adolescents, peripheral oedema, bone density decreased. Legal
inhalation solutioi corticosteroids. Possible systemic effects include Cushing's syndrome, Cushingoid Category: POM Packs and Prices: Fostair 100/6 PL08829/01 56) £29.32. Each
Prescribing Information features, adrenal suppression, decrease in bone mineral density, growth retardation in inhaler contains 120 actuations. Full prescribing information is available from the
(Refer to Summary of Product Characteristics before prescribing). children and adolescents, cataract and glaucoma. Titrate to the lowest dose at which Marketing Authorisation Holder Chiesi Limited, Cheadle Royal Business Park,
Presentations: Pressurised inhalation solution containing 100 micrograms of effective control of asthma is maintained to minimise systemic effects. Special care Highfield, Cheadle, SK8 3GY. Date of preparation: July 201 0.

beclometasone dipropionate and 6 micrograms of formoterol fumarate dihydrate per is needed in transferring patients from oral steroids. Fostair contains a small amount
actuation. Indications: Regular treatment of asthma where use ot a combination of ethanol (approximately 7mg per actuation); at normal doses the amount of ethanol REFERENCES
product (inhaled corticosteroid and long-acting beta 2 -agonist) is appropriate: patients is negligible and does not pose a risk to patients. Patients should rinse mouth after 1 . De Backer W, Devolder A, Poli G et al. Lung deposition of BDP/formoterol HFA
not adequately controlled with inhaled corticosteroids and 'as needed' inhaled inhalation to minimise risk of oropharyngeal Candida infection. Drug interactions: pMDI in healthy volunteers, asthmatic and COPD patients. J Aerosol Med Pulm
short-acting beta2 agonist; or patients already adequately controlled on both inhaled Beclometasone dipropionate undergoes a very rapid metabolism via esterase Drug Deliv 2010; 23(3): 137-148.
corticosteroids and long-acting beta2 -agonists. Not appropriate for treatment of acute enzymes without involvement of the cytochrome p450 system. Avoid beta-blockers 2. Selroos 0, Pietinalho A, Riska H. Delivery devices for inhaled asthma medication.
asthma attacks. Dosage and Administration: For inhalation use only. Fostair is (including eye drops). Caution is required when theophylline or other beta-adrenergic Clin Immunother 1996; 6: 273-299.
not intended for the initial management of asthma. If an individual patient should drugs are prescribed concomitantly with formoterol. Concomitant treatment with 3. Fabbri LM, Nicolini G, Olivieri D et al. Inhaled beclometasone dipropionate/
require a combination of doses other than those available in the combination inhaler, quinidine, disopyramide, procainamide, phenothiazines, antihistamines, MAOIs and formoterol extra-fine fixed combination in the treatment of asthma: evidenc'e
appropriate doses of beti-agonists and/or corticosteroids by individual inhalers should TCAs can prolong the QTc and increase the risk of ventricular arrhythmias.
interval and future perspectives. Expert Opin Pharmacother 2008; 9: 479-490.
be prescribed. Adults: one or two inhalations twice daily, maximum four inhalations In addition, L-dopa, L-thyroxine, oxytocin and alcohol can impair cardiac tolerance. 4. Tulic MK, Hamid Q. New insights into the pathophysiology of the small airways
daily. Not recommended for patients under 1 8 years. Beclometasone dipropionate Concomitant administration with MAOIs, including agents with similar properties such in asthma. Clin Chest Med 2006; 27: 41-52.

in Fostair is characterised by an extra-fine particle size distribution which results in as furazolidone and procarbazine, may precipitate hypertension. Risk of arrhythmias 5. Huchon G, Magnussen H, Chuchalin A et al. Lung function and asthma contra
a more potent effect than formulations of beclometasone dipropionate with a non in patients receiving anaesthesia with halogenated hydrocarbons. Theoretical potential with beclomethasone and formoterol in a single inhaler. Respir Med 2009 1 03 ;

extra-fine particle size distribution (100 micrograms of beclometasone dipropionate for interaction in sensitive patients taking disulfiram or metronidazole. Pregnancy 41-49.
extra-fine in Fostair are equivalent to 250 micrograms of beclometasone dipropionate and Lactation: No experience. Balance risks with benefits. Side effects: Common:
in a ncn extra-fine formulation). Therefore the total daily dose of beclometasone pharyngitis, headache, dysphonia. Uncommon: influenza, oral fungal infection AeroChamber Plus™ is a licensed trademark of Trudell Medical Internation

dipropionate administered in Fostair should be lower than the total daily dose of pharyngeal and oesophageal candidiasis, vaginal candidiasis, gastroenteritis Date of preparation: JULY 2010 Job code: CHFOS20100392
1

beclometasone dipropionate administered in a non-extra-fine beclometasone sinusitis, granulocytopenia, dermatitis allergic, hypokalaemia, hyperglycaemia
dipropionate formulation. Fostair may be used with the AeroChamber Plus™ spacer restlessness, tremor, dizziness, otosalpingitis, cardiac arrhythmias, hyperaemia
device. Patients' should be advised in the proper use and care of their inhaler and flushing, rhinitis, cough, productive cough, throat irritation, asthmatic crisis, pruritus GChiesi
spacer. Contraindications: Hypersensitivity to any of the components. Precautions: . rash, hyperhidrosis, diarrhoea, dry mouth, dyspepsia, dysphagia, burning sensation of
Cardiovascular disorders including cardiac arrhythmias, thyrotoxicosis, diabetes the lips, nausea, dysgeusia, muscle spasms, myalgia, Crreactive protein increased
mellitus, '
phaeochromocytoma, untreated hypokalemia, pulmonary infections platelet count increased, free fatty acids increased, blood insulin increased, blood Adverse events should be reported.
(tuberculosis^ fungal or viral). Fostair should not be used as the first treatment for ketone body increased. Rare: ventricular extrasystoles, angina pectoris, paradoxical Reporting forms and information can be found at www.yellowcard.gov.uk
asthma, should not be initiated during an exacerbation, or during significantly bronchospasm, urticaria, angioneurotic oedema, nephritis, blood pressure i
Adverse events should also be reported to Chiesi Limited (address as above
worsening or acutely deteriorating asthma, and should not be stopped abruptly. If blood pressure decreased. Very
patients find the treatment ineffective medical attention must be sought. Systemic adrenal suppression, abnormal