ITK December/January 2015 - Issue 39

ISSUE #39 : DECEMBER 2014 / january 2015

P r a c t ic a l I n f o r m at i o n f o r T o d a y ’ s C o m m u n i t y P h a r m a ci s t

IN THE KNOW

• It’s a matter of trust

• Healthy weight

• Business profile

• Down to business

• CPD – It’s Quittin’ Time!

• Training and Education

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CONTENTS

Merry CHRISTMAS

After Hours 52 Rolex Sydney Hobart Yacht Race

Business Profile 8 Ezy-Ups

Down to Business

BY SEAN TUNNY Editor, Gold Cross Products & Services Pty Ltd

5 Non-verbal signals to look for when interviewing

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24 So, what’s the plan?

26 Impress your customers 36 The Secret 38 Christmas and the New Year

Guild News 3 It’s a matter of trust

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Professional Review Well, where has 2014 gone? As this edition of ITK is being delivered to Pharmacy throughout Australia, one of the busiest seasons in Retail and life in general outside Pharmacy is well upon us, that time being the exciting and festive Christmas season.

In visiting a number of Pharmacies over recent weeks, the Christmas gifts and retail theatre as it is affectionately known is in full swing. While the front of store activity is busy so too Pharmacists enter one of their busiest times in the dispensary.

This edition of ITK has a range of editorial on smoking cessation or NRT as it is commonly referred to in Pharmacy.

We also had the opportunity to speak with the Marketing Director of Ezy-Ups regarding the exciting plans for the company in 2015, exclusively Pharmacy only.

6 Get your pharmacy ready for the New Year Resolution and start promoting ClickFit 18 Healthy Weight 28 Mind-altering microbes

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Regulars 44 What’s New and Company News 48 Product Spotlight 54 60 Seconds with 55 Classifieds 56 Health Calendar

Retail Focus 32 Tying it all Together!

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Special Feature 10 It’s Quittin’ Time

Training and Education

In drawing a festive close on this welcome, I would like to extend a sincere thank you to all our contributors and many partners in 2014. The success of our publication is due to your overwhelming support.

41 Weight Loss for Life

On behalf of all the team at Gold Cross, we would like to take this opportunity to wish you and your family a Merry Christmas and a safe and prosperous New Year.

PLEASE USE THIS PUBLICATION TO KEEP YOUR PHARMACY IN THE KNOW.

Best Regards, Sean Tunny Editor

42 A Little Bit of Relief 43 CROMO-FRESH eye drops

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EDITOR: Sean Tunny

0457 029 052 sean.tunny@goldx.com.au DESIGN: Megan Hibberd

0408 452 133 www.artbymegan.com.au PRINT & DISTRIBUTION: APN Print

1300 134 628 www.apnprint.com.au

BROUGHT TO YOU BY: PUBLISHED BY: Gold Cross Products & Services. PO Box 505 Spring Hill Qld 4004.

Contact Jessica O’Connor – Email: jessica.oconnor@goldx.com.au. In The Know is produced for the information of Australian Pharmacists. The presence of the logo of the Pharmacy Guild does not constitute endorsement of a product. The Pharmacy Guild of Australia accepts no responsibility for claims made by advertisers. Opinions and views expressed in articles do not necessarily reflect those of Gold Cross.

NEWS FROM THE GUILD PRESIDENT

It’s a matter of trust

George Tambassis National President of The Pharmacy Guild of Australia

At the Guild, we consider it a privilege to be a champion of community pharmacies and their exceptionally professional staff who are so devoted to serving their patients to the best of their ability every day.

Australia has the best community pharmacy system in the world, in our opinion, and we should be celebrating this fact and making sure we build on it.

That is why the Discover More. Ask Your Pharmacist campaign which hit television screens and websites in October is so important, and I am very pleased that it has had such a good reaction and so much support across the industry.

It will be taking a break over Christmas, but back on the air in the New Year until late February.

In a very positive way, the campaign reinforces the crucial role played by community pharmacies, not only dispensing medicines, but also looking after the broader health needs of their patients.

It reminds the public that community pharmacists are highly qualified health care professionals.

Most of all, the Discover More. Ask Your Pharmacist campaign portrays community pharmacy as delivering the patient-focused solutions that will enable it to fulfil its true

potential as a highly accessible, valued and trusted health care destination.

And we do know for sure that the public trust pharmacies and their staff. Recently the Roy Morgan company’s research has confirmed once again the very high levels of patient satisfaction with community pharmacies.

The research found patient satisfaction levels with pharmacy groups ranged from the mid-eighties to over ninety per cent.

A large number of other pharmacy patient surveys over a prolonged period of time have also consistently found that patients highly value their community pharmacies, are very satisfied with the service they receive from them, and believe that pharmacies deliver both value-for-money and a high level of accessibility and convenience.

internationally, in support of a greater role for pharmacies and pharmacists in the wider health system.

So, that’s why I believe everyone working in pharmacy needs to nurture and cherish the level of trust our patients and customers have in our services. We must not take it for granted.

As change occurs in the industry over the coming years – especially changes that make us stronger and add to the health care of all Australians – it is very important that the people who have supported pharmacy so openly and loyally for so many years are brought along in the process, consulted, and made the ongoing priority of the health system of which community pharmacy is such an integral part.

As a sector, we have a great opportunity to harness these high levels of public support to deliver the transformational change that is required to secure the future of community pharmacy and the pharmacist profession.

There is no doubt that there is an evergrowing momentum, both in Australia and GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 39 : DECEMBER 2014 / JANUARY 2015

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“By taking non-verbal and verbal communication into consideration, you can make an informed decision.”

DOWN TO BUSINESS

Non-verbal signals to look for when interviewing Graham Howard Agency Owner, Frontline Health

If you are interviewing a candidate for a position in your Pharmacy, it’s important that you have all the information you need so that you can make an informed hiring decision.

Although a candidate may look great on paper and might say all the right things during an interview, how can you tell for sure if they are really as good as they seem? Non-verbal signals, known as body language, can hold the key to whether or not your apparently wonderful candidate will be a good fit for your organisation.

We all subconsciously observe and process non-verbal cues when we interact with people, but without being consciously aware of them we might not realise their significance. Here are a few body language signals which can tell you whether your interviewee is sincere, interested and confident in their abilities.

Posture How a person sits and holds themselves is an important indicator of how self-assured they are, and whether they are interested in the person who is interviewing them.

Someone who is confident and interested will sit upright, leaning towards the interviewer slightly. Their overall posture will be relaxed but not slumped. Leaning back can indicate disinterest, and slumping can mean they are bored and not really interested.

Eye contact It is important that the person you are interviewing looks you in the eye when you are speaking to them. Maintaining good eye contact shows they are focused on you and interested in what you are saying. If they won’t look you in the eye, or their eyes are darting around the room, it could indicate dishonesty, disinterest or excessive nerves.

An overly direct stare can also be confronting and may be a sign of an aggressive, dominating personality – too much eye contact is just plain creepy.

Fidgeting People often fiddle when they are nervous, but excessive fidgeting can also be a sign of irritation and may indicate that someone has a highly strung and/or impatient personality, and may not be an ideal employee, especially in high pressure situations.

It’s important to make a hiring decision based on all the information you have available. By taking non-verbal and verbal communication into consideration, you can make an informed decision and hopefully reduce the chances that your newly hired candidate will turn out to be a poor fit for your Pharmacy.

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Professional review

Get your pharmacy ready for the New Year Resolutions and start promoting

ClickFit

A cutting edge online weight management tool now available in your pharmacy

BY ROMA CECERE General Manager – Strategic Business Performance, GuildCare

“Pharmacies are in the perfect position to assist customers with weight management by incorporating pharmacy services to create a comprehensive lifestyle program.”

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 39 : DECEMBER 2014 / JANUARY 2015

Professional review

GuildLink has partnered with SP Health, a leading consumer health business that develops innovative online lifestyle programs, to deliver ClickFit on the GuildCare platform.

ClickFit is a cutting edge online health tool that is designed to manage weight loss, fitness and nutrition.

The ClickFit program provides its members with a supportive and educational environment through which they can achieve their health goals. With scientifically supported features, the 100% online and mobile platform encourages behaviour change to improve diet, physical activity and overall wellbeing.

It includes easy-to-use online tools such as menu plans, food and exercise diaries, exercise plans and videos, and comprehensive nutrition analysis.

Customers can choose from a range of different menu plans including a Meal Replacement Program designed to work with most of the leading meal replacement products sold in your pharmacy.

Pharmacies are in the perfect position to assist customers with weight management by incorporating pharmacy services to create a comprehensive lifestyle program.

Depending on the pharmacy model, ClickFit can be offered as a program on its own or with:

•• Meal Replacement Shakes – Combine meal replacements for customers on the run trying to maintain caloric intakes •• Wearable Devices – Coming soon, some devices will sync with ClickFit to provide the customer with holistic feedback on their activities and eating The above options can be further supported by incorporating Pharmacy Services available in GuildCare software, such as Weight Recording services for regular weigh-ins, as well as Blood Glucose, Blood Pressure and Lipid Recording services for customers who may require monitoring. Pharmacies can also create a tailored Patient Plan which showcases all the services that the pharmacy offers, either their own or through GuildCare, to assist the customer even further.

Pharmacies that are subscribed to MemoCare, or alike, can utilise their communication tool to send customers reminders for scheduled services such as weigh-ins, which brings customer loyalty to the pharmacy.

The ClickFit pharmacy program is exclusively available through GuildCare where pharmacy staff promote and enrol customers to ClickFit in-store or alternatively supply customers who are interested with a unique URL to enrol themselves at their own leisure.

The GuildCare ClickFit program provides pharmacy remuneration for customer enrolments and ongoing monthly revenue for enrolled customers.

Additional information on ClickFit: The program is conveniently accessible via desktop, tablet or mobile so customers receive all the support, coaching and motivation they need to reach their weight loss, fitness or nutritional goals. Features include:

•• A choice of comprehensive 12-week programs, including a generic meal replacement option that can be used with any pharmacy meal replacement product

•• Individual weekly meal plans with delicious, healthy recipes

•• Tailored weekly exercise plans with videos •• An easy-to-use food and exercise diary to track your daily calorie intake

•• A food search with over 200,000 foods •• Weigh in reminders and nutritional charts to check your progress

•• Motivational and educational tools •• Support by a team of customer service professionals With the year coming to an end, it’s a great time to position your pharmacy for weight management that supports customers with their New Year Resolutions initiatives.

For additional information, please contact GuildCare Support at support@guildcare.com.au.

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BUSINESS PROFILE

Ezy-Ups – All about Quality of Life

BY SEAN TUNNY Editor, Gold Cross Products & Services Pty Ltd

Editor: Could you please share with our readers a little of the Ezy-Ups story?

Ezy-Up: It all started when Ezy-Ups’ designer and Company founder Bill Carbray and his wife, were put into a carer situation when Bill’s mother had a fall. In her nineties, she is fiercely independent and was really upset and depressed having somebody ‘change’ her.

Bill could not find any existing equipment which would help his mother, so he made his own and Ezy-Ups was invented. Since then, Ezy-Ups has been refined and improved significantly to suit more types of clothing and all disposable pants available in Pharmacies.

Editor: The Ezy-Ups mission is to allow people to regain their dignity and independence, by giving them the ability to remove and put on clothing with no or minimal assistance. How was this mission statement derived?

Ezy-Up: Caring for oneself is a basic human right. When this is taken away by age, injury or even pregnancy, it often means that one becomes dependant on others for simple everyday tasks such as toileting and dressing.

This is usually a shock for anyone finding themselves in this situation. Very often, the main problem is simply that they cannot bend their backs enough to reach their feet and have to rely on assistance. This is often not available immediately, so waiting for help is often a regular part of the day. Ezy-Ups was developed for this reason. Dignity and Independence.

Editor: People are a key part of an organisation. This is not more truthful when referring to your staff, on a number of levels. Why are people, or importantly the quality of staff so important to Ezy-Ups? Ezy-Up: Ezy-Ups has come together over the last four years with a small core of talented business people who are experts in their areas. The bringing together of this group has made Ezy-Ups possible with relatively small capitalization, when compared to other similar companies.

As well as being the Marketing Director of Ezy-Ups Ltd, I have been the business consultant and mentor for about 200 new businesses. Through this I have access

“Caring for oneself is a basic human right.

When this is taken away by age, injury or even pregnancy, it often means that one becomes dependant on others for simple everyday tasks.”

“Ezy-Ups has come together over the last four years with a small core of talented business people who are experts in their areas.”

to a wide variety of small business people who are often just starting out, talented, competitive and enthusiastic. This has given us a competitive advantage in developing Ezy-Ups, as we have been able to successfully outsource many functions locally.

Editor: Ezy-Ups is looking to build a long and interactive professional alliance with Pharmacy. How do you foresee this relationship strengthening as Ezy-Ups develops?

Ezy-Up: Pharmacies are our only distribution channel to the general public. We chose this distribution method mainly due to the interaction of Pharmacy staff with their customers. Pharmacies offer true customer service and not just someone trying to sell something. Our main target market is ‘old and elderly people’ who often rely on their local Chemist for advice and service. Ezy-Ups is not a fad or fashionable product, we expect that Ezy-Ups will be a familiar sight in pharmacies for many years to come.

Editor: In considering your R&D, packaging, distribution, training, sales and marketing, how does the organisation approach these key functions of the business?

Ezy-Up: Ezy-Ups Ltd has developed due to the talents the four Board members.

Each party has often had to argue and present their case to the Board and sell their idea.

This has meant that every move has been well researched and refined by the time it gets to the Board Room.

Even though we are all geographically close, the Board is often presented with formal proposals by individual members, which is

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BUSINESS PROFILE

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“Pharmacies are well distributed throughout Australia, are well respected and provide excellent service and advice to their customers.

We could hardly ask for more from our distribution channel.”

unusual in a small company. This formality has meant that professionalism is absolute and capital is spent wisely and is results orientated.

Editor: Your role in the company is a dynamic and diverse one with a number of key responsibilities. Could you please provide a little more detail?

Ezy-Up: As Marketing Director and having been with Ezy-Ups for most of its existence, there isn’t much I haven’t been involved in some way. As I am always saying to my other entrepreneurs, they need to use ALL their resources, energy and experience if they want be the best at what they do.

I have done this with Ezy-Ups, using experience which I gained over nearly 40 years in business, including a few years working in my family owned pharmacy, many years ago.

Editor: Ezy-Ups do not distribute via grocery channels, why has this been your chosen position?

Ezy-Up: If we expect Pharmacies to support Ezy-Ups, we also have to be prepared to commit to them. Pharmacies are well distributed throughout Australia, are well respected and provide excellent service and advice to their customers.

We could hardly ask for more from our distribution channel.

Editor: Do you have any specific goals or objectives regarding your business and the profession in general for 2015 and beyond?

Ezy-Up: We are looking for Ezy-Ups to be widely available throughout Australia during 2015. This means that a significant number of Pharmacies will need to stock Ezy-Ups. With Doward International as our distributor and with significant advertising support in National media, we are confident that this will happen.

Ezy-Ups Distributed by Doward International 50 Malcolm Rd, Braeside VIC 3195

www. www.ezyups.com

(03) 8587 4600

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CONTINUING PROFESSIONAL DEVELOPMENT

“Evidence suggests that the successful quit rate can reach as high as 15–20% with combined pharmacotherapy and behavioural support.”

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 39 : DECEMBER 2014 / JANUARY 2015

CONTINUING PROFESSIONAL DEVELOPMENT

It’s Quittin’ Time!

Smoking Cessation Strategies for Pharmacists As one year ends and another begins, for many this brings about a time to reflect on the year passed and think forward to the year that is coming. For many Australians, this time of reflection may involve an attempt to quit smoking as part of their New Year’s resolution.

As the reality of these resolutions begins to set in, pharmacists and community pharmacy are well placed to play a vital role in assisting customers with strategies to quit.

Smoking is the leading cause of preventable death for Australians, being well established as a major cause of heart disease, stroke, chronic obstructive pulmonary disease (COPD), some cancers and a number of other health ailments. In the 2004/2005 financial year, the total social cost of tobacco use in Australia was $31.5 billion, accounting for 56% of the total social costs of all drugs (including alcohol and illicit drugs).1

Tim Roberts B.Pharm (Hons), AACPA, DipBusMgt Professional Development Manager; Pharmacy Guild of Australia QLD

With the ease of access to a health professional, community pharmacy is a perfect destination point for individuals considering quitting smoking. Pharmacists can advise on the wide range of evidencebased Nicotine Replacement Therapy (NRT) products, as well as assist individuals in determining their readiness to quit while also maintaining their motivation to quit.

Learning Objectives After reading this article, the learner should be able to:

•• Recognise effective counselling strategies based on an individual’s ‘stage of readiness’ to quit smoking.

•• Identify the major disease and health risks associated with smoking.

•• Identify the appropriate initial therapy dosing for Nicotine Replacement Therapy (NRT) products.

•• Recognise the mechanisms by which smoking can have pharmacokinetic interactions with other medications.

•• Identify pharmacodynamic interactions between smoking and medications.

Competencies Addressed

Assessing Quitting Stage – Ready or Not? One of the first steps in the journey to quitting is to understand the process involved in changing behaviours. Providing this advice in addition to pharmacotherapy treatment strategies, will likely lead to a more successful quitting attempt.

The ‘Stage of Readiness to Change’ model as proposed by the Supporting Smoking Cessation: Guidelines for Australian General Practice is a valuable tool in assessing an individual’s readiness to change a variety of behaviours, including smoking.2,3 Readiness to change is fluid, so many people may move their stages at different intervention with the pharmacist; however, individuals who smoke, broadly fall into one of the following five (5) categories2,3:

•• Not ready (pre-contemplation) – Not seriously thinking of quitting

2.1, 4.2, 6.1, 6.2, 7.1

•• •• •• ••

in the next 6 months.

Unsure (contemplation) – Considering quitting in the next 6 months.

Ready (preparation) – Planning to quit in the next 30 days.

Action – Individuals who have quit in the last 6 months.

Maintenance – Smokers who have been abstinent for more than 6 months.

Some key questions to ask individuals to gauge their quitting readiness are open-ended approaches such as ‘How do you feel about your smoking at the moment?’ and also clarifying questions to determine whether the individual is ready to make a quitting attempt, for example ‘Are you ready to quit now?’

Once an individual is able to identify their readiness to quit, pharmacists can then tailor advice to their particular stage of readiness.

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CONTINUING PROFESSIONAL DEVELOPMENT

Motivating Patients to Take Action Brief motivational interviewing is a key skill for assisting the ‘contemplation’ group of smokers, those who are ambivalent about smoking and are looking for motivation to change their habits. Weighing up the ‘pro’s and cons’ of quitting smoking can be useful for these patients and may assist in tipping the balance by exploring alternatives, identifying reasons for changes/risks in not changing, and increasing an individual’s confidence in their ability to change.

Asking a patient to self-rate their motivation and confidence on a scale of 1 to 10 can be a useful exercise, as it is generally easy for patients to understand and allows for pharmacists to better tailor their intervention.3 Determining motivation and confidence can provide an insight into the barriers to quitting and can also be used to frame a conversation around what the specific benefits of quitting may be in an individual’s own circumstance.

An effective technique to help patients identify their reasons for quitting is to reinforce the health benefits of a smoke-free lifestyle:

•• Smoking and disease2,3: Smoking causes lung cancer (20 times the risk of non-smokers), chronic bronchitis, emphysema and is a major risk factor for ischaemic heart disease (10 times the risk of a non-smoker), peripheral vascular disease and stroke. Additionally, smoking is also associated with other cancers including: oral, laryngeal and oesophageal, pancreatic, bladder and cervical cancer.

Smoking and the body2,3: Smoking is an important risk factor for age-related macular degeneration which is a leading cause of blindness in older Australians. Smoking can also affect the skin, causing premature

Table 1. Choosing an effective approach2 Pre-contemplation

•• Show interest and encourage the patient to think about the issues.

Contemplation

•• Motivate change and offer to help identify and overcome barriers.

Preparation

•• Provide assistance – develop a quit plan.

•• Suggest coping strategies (delay, deep breathing, drink water, do something else).

•• Assist with appropriate pharmacotherapy (where indicated).

Action

•• Congratulate on progress!

•• Check for problems and advise/refer appropriately.

Maintenance

•• Congratulate and reinforce the benefits of being a non-smoker.

Table 2. Timeline of benefits for Smoking Cessation2 12 hours

•• Almost all the nicotine has been metabolised

24 hours

•• Blood levels of carbon monoxide drop dramatically

5 days

•• Most nicotine by-products have been removed •• Sense of taste and smell improve

6 weeks

•• Risk of wound infection after surgery substantially reduced

3 months

•• Cilia begin to recover and lung function improves

1 year

•• Risk of coronary heart disease is halved after one year compared to continuing smokers

10 years

•• Risk of lung cancer is less than half that of a continuing smoker and continues to decline

10–15 years +

•• Risk of coronary heart disease the same as a non-smoker •• 10 to 15 years after quitting the all-cause mortality in former smokers declines to the same level as people who have never smoked.

sagging and wrinkling, as well as being associated with delayed wound healing.

Smoking can be a factor in gum disease (gingivitis) which can lead to loss of teeth.

•• Smoking and men’s health2,3: In men, smoking can lead to erectile dysfunction and is also associated with hair loss.

•• Smoking and women’s health2,3: In women, smoking is associated with earlier onset of menopause and is a risk factor for osteoporosis.

Smoking in pregnancy increases the risk of miscarriage, premature birth and

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low-birth-weight babies (more likely to have perinatal health problems).

•• Smoking and children2,3: Children exposed to environmental tobacco smoke are more likely to get respiratory infections such as bronchiolitis, and middle ear infection.

They are also at increased risk of SIDS. In addition to framing the conversation around the health benefits for individuals in smoking cessation, it can also be useful to provide a timeline for the health improvements to be gained from stopping smoking (see table 2).

CONTINUING PROFESSIONAL DEVELOPMENT

Treatment Strategies to Kick the Habit

Smoking the first cigarette within 30 minutes of waking up

In addition to providing motivation and support to quit smoking, community pharmacists have a wide variety of over-thecounter pharmacotherapy interventions at their disposal to ensure the best outcomes for those seeking assistance in kicking the habit.

Evidence suggests that the successful quit rate can reach as high as 15–20% with combined pharmacotherapy and behavioural support.3 Nicotine Replacement Therapy (NRT) products have been shown to reduce the severity of nicotine cravings, signs of which include3,4,5:

•• smoking the first cigarette within

Signs of nicotine cravings

30 minutes of waking up

•• smoking more than 10 cigarettes per day (regardless of strength of nicotine in cigarettes) •• withdrawal symptoms such as cravings, irritability, anxiety, depression, restlessness and poor concentration (within 24 hours of stopping smoking).

Commercially available NRT products include transdermal patches, inhalers, gums, lozenges and mini-lozenges – there are no significant differences in effectiveness between the different forms available.3 Smoking more than 10 cigarettes per day

Withdrawal symptoms such as cravings, irritability, anxiety, depression, restlessness and poor concentration

Discussing smoking habits and identifying needs is the first step, followed by choosing an appropriate starting dose with the chosen dosage form and discussing the dosage form specific potential adverse effects. See table 3 below for a summary of NRT initial dosing and counselling.2,3,5

Table 3. Nicotine Replacement Therapy (NRT) initial dosing guidelines2,3,5 Profile Group

Dose

Duration

>10 cigs per day and weight >45kg

21mg/24hr patch or 15mg/16hrs

>8 weeks

<10 cigs per day or weight < 45kg or CVD

14mg/24 patch or 10mg/16hrs

>8 weeks

>10 and <20 cigs per day

2mg gum, 8–12 per day

>8 weeks

>20 cigs per day

4mg gum, 6–10 per day

>8 weeks

>10 cigarettes per day

6–12 cartridges per day

>8 weeks

First cigarette >30 mins after waking

2mg lozenge,

>8 weeks

First cigarette <30 minutes after waking

1 lozenge every 1–3 hours

>8 weeks

Low dependence

2mg tablet every 1–2hrs

>8 weeks

High dependence

Two 2mg tablet every 1–2hrs

>8 weeks

Patch

Gum

Inhaler

Lozenge

Sublingual Tablet

Adverse effects Skin erythema and allergy, insomnia, wild dreams (more with 24 hr patch)

Dyspepsia, nausea, headache, hiccup, dental problems Mouth and throat irritation, cough Dyspepsia, nausea, hiccup, headache Headache, nausea, dyspepsia, sore, dry or burning mouth, cough

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CONTINUING PROFESSIONAL DEVELOPMENT

“Utilise your unique position in community pharmacy to not only provide your customers with appropriate pharmacotherapy to give up smoking, but also with the strategies and motivation to kick the habit for good this year!”

Contraindications to NRT include recent myocardial infarction, recent cerebrovascular event and severe arrhythmia.2 For people who fall into this category, a referral to a General Practitioner (GP) would be the most appropriate intervention – so that in conjunction with their clinician they may make an informed choice of the risks vs. benefits to using NRT in these situations.2 Consideration should be given to pregnant women where the effects of low nicotine exposure on the human foetus are unclear (ADEC category D) and lactation where the benefit of using NRT may outweigh the risk.2 In pregnant women, non-patch products should be considered first as they deliver a lower amount of nicotine and thereby reduce the exposure to the foetus.6,7 In breastfeeding women, it is recommended to use non-patch forms also (i.e gums, lozenges, inhalers).6,7 To assist both patients and practitioners in deciding upon the most appropriate approach to quitting in pregnancy, some useful information can be found on the QUITline organisation website www.quit.org.au/about/ frequently-asked-questions/faqs-pregnancyand-quitting-smoking Prescription products indicated for smoking cessation include bupropion and varenicline. Whilst both are regarded as effective treatment strategies, varenicline has been evidenced to be more effective than bupropion in randomised controlled trials with a 12-week treatment period finding that abstinence rates were higher with varenicline than with sustained release bupropion.3,8 Nausea is the most common adverse effect associated with varenicline treatment; however, patients should be advised to report any unusual mood changes, depression, behavioural disturbance and suicidal thoughts as these would be cause to stop taking the medication.3

Smoking and Medications: Considerations for Pharmacists In addition to providing appropriate NRT products and advice, pharmacists should also consider the implications of the patient medication history in some individuals who wish to quit smoking. The chemicals in smoke may interact with some antipsychotics, antidepressants, oral contraceptives and opiates such as methadone.9 Pharmacokinetic Interactions: Cigarette smoking induces the activity of cytochrome P450 (CYP) 1A2 (via chemicals in cigarette smoke such as polycyclic aromatic hydrocarbons) and also CYP2B6.10,11 The effect of smoking on hepatic enzymes is not related to the nicotine component of tobacco.

NRT does not influence CYP1A2 activity.9 Some specific examples of these pharmacokinetic interactions to consider include:

•• Clozapine and Olanzapine9,12: Cigarette smoking induces the metabolism of antipsychotics Clozapine and Olanzapine, resulting in lower plasma concentrations.

The daily consumption of 7–12 cigarettes is probably sufficient to cause the maximum induction of clozapine and olanzapine metabolism. Evidence shows that a 50% difference in the mean daily dose of clozapine is needed by smokers compared to non-smokers, to reach a given blood concentration.

•• Antidepressants9,13: As the SSRI antidepressant fluvoxamine is metabolised by CYP1A2, smokers might require higher doses than those recommended from clinical trial data.

Smoking is not anticipated to alter the pharmacokinetics of other selective serotonin reuptake inhibitors as they are not substrates of CYP450 isoenzymes induced by smoking.

Smokers might require higher than normal doses of the tricyclic

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antidepressant imipramine. They do not appear to require dose adjustments of amitriptyline, nortriptyline or clomipramine.

Pharmacodynamic drug interactions: The additive or antagonising type of pharmacodynamic drug interaction with cigarette smoking is largely due to nicotine.9 Some specific examples of pharmacodynamics interactions to consider include:

•• Methadone9,14: A large proportion of patients using methadone for Opiate Replacement Therapy (ORT) also smoke cigarettes. Methadone doses have been found to be higher in heavy smokers and methadone has been shown to increase both smoking rates and smoking satisfaction. Nicotine affects the endogenous opioid system; thereby cigarette smoking enhances the effect of methadone on opioid withdrawal symptoms. Conversely, methadone reduces symptoms of nicotine withdrawal and as such, reducing methadone doses whilst simultaneously attempting to quit smoking may have detrimental effects.

•• Oral Contraceptive Pill9,15: Smoking has been shown to increase the adverse effects of the combined oral contraceptive pill (specifically thromboembolism, ischaemic stroke and myocardial infarction). The combined oral contraceptive pill is recommended to be avoided in women aged 35 years or older who smoke.

So, what’s the time…?

It’s quittin’ time! Utilise your unique position in community pharmacy to not only provide your customers with appropriate pharmacotherapy to give up smoking, but also with the strategies and motivation to kick the habit for good this year!

CONTINUING PROFESSIONAL DEVELOPMENT

ASSESSMENT QUESTIONS

1 Collins D, Lapley H. The costs of tobacco, alcohol and illicit drug abuse in Australian society in 2004–2005. Canberra: Department of Health and Ageing; 2008 2 Smoking Cessation Guidelines for Australian General Practice: Patient education material.

Canberra: Department of Health; 2011 3 Supporting Smoking Cessation: A Guide for Health Professionals. Melbourne. The Royal Australian College of General Practitioners, 2011. [Updated July 2014] 4 Henningfield J, Fant R, Buchhalter A, Stitzer M. Pharmacotherapy for nicotine dependence.

California. Cancer Journal for Clinicians 2005;55(5): 281–299 5 Kozlowski L, Giovino G, Edwards B et al. Advice on using over-the-counter nicotine replacement therapy – patch, gum, or lozenge – to quit smoking.

Addictive behaviours 2007; 32(10):2140–2150 6 eMims Reference. Product Information [Nicorette Chewing Gum]. Sydney: MediMedia Australia Pty Ltd; 2014 7 eMims Reference. Product Information [Nicabate, Nicabate clear, Nicabate Pre-Quit patches]. Sydney: MediMedia Australia Pty Ltd; 2014 8 Jorenby D, Hays J, Rigotti N, et al. Efficacy of Varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial antagonist vs placebo or sustained release bupropion for smoking cessation: a randomized controlled trial. JAMA. 2006;296:56–63 9 Lucas C, Martin J. Smoking and drug interactions.

Australian Prescriber 2013; 36(3): 102–104.

10 Zhou SF, Yang LP, Zhou ZW, Liu YH, Chan E. Insights into the substrate specificity, inhibitors, regulation, and polymorphisms and the clinical impact of human cytochrome P450 1A2. AAPS J 2009;11:481–94.

11 Washio I, Maeda M, Sugiura C, Shiga R, Yoshida M, Nonen S, et al. Cigarette smoke extract induces CYP2B6 through constitutive androstane receptor in hepatocytes. Drug Metab Dispos 2011;39:1–3.

12 Haslemo T, Eikeseth PH, Tanum L, Molden E, Refsum H. The effect of variable cigarette consumption on the interaction with clozapine and olanzapine. Eur J Clin Pharmacol 2006;62:1049–53.

13 Desai HD, Seabolt J, Jann MW. Smoking in patients receiving psychotropic medications: a pharmacokinetic perspective. CNS Drugs 2001;15:469–94.

14 Elkader AK, Brands B, Selby P, Sproule BA. Methadone-nicotine interactions in methadone maintenance treatment patients. J Clin Psychopharmacol 2009;29:231–8.

15 Combined Oral Contraceptive [updated Jan 2014].

In: AMH [Internet]. Adelaide: Australian Medicines Handbook Pty Ltd.; 2014 [Accessed 8/10/2014]

question 4

According to the ‘stages of readiness’ model for smoking cessation, which of the following approaches would be MOST beneficial for someone in the ‘contemplation’ stage?

Which of the following statements BEST describes the mechanism of pharmacokinetic interactions with cigarette smoking?

a. Develop a quit plan with a timeline.

a. Hepatic clearance of nicotine in cigarette smoke.

b. Congratulate the person on their achievement.

b. Cigarette smoking induces the activity CYP1A2 and CYP2B6.

c. Provide motivation for change and identify any barriers to quitting.

c. Cigarette smoking inhibits the activity CYP1A2 and CYP2B6.

d. Discuss coping strategies to help deal with cravings.

d. Renal clearance of polyaromatic hydrocarbons in cigarette smoke.

question 2

question 5

Which of the following statements regarding the health impacts of smoking is INCORRECT?

Which of the following is an example of a medication that has a pharmacodynamic interaction with smoking?

a. A smoker has approximately a 20 times higher risk of developing lung cancer than a non-smoker.

a. Clozapine

b. Smoking is associated with a later onset of menopause in women.

b. Fluvoxamine c. Methadone d. Amitriptyline

c. Smoking has been shown to be an important risk factor in age-related macular degeneration. d. In pregnant women, smoking increases the risk of premature and low-birthweight babies.

question 3 Which of the following recommendations is MOST appropriate as a general guide for commencing an NRT patch? a. If daily smoking habit is 10 cigarettes or less, initially recommend 21mg/24hr patch for 8 weeks duration. b. If daily smoking habit is greater than 10 cigarettes, initially recommend 14mg/24hr patch OR 10mg/16hr patch for duration of 8 weeks or more. c. If daily smoking habit is 10 cigarettes or less, initially recommend 15mg/16hr patch for 4 weeks duration. d. If daily smoking habit is greater than 10 cigarettes, initially recommend 21mg/24hr patch OR 15mg/16hr patch for duration of 8 weeks or more.

ANSWERS: Question 1 – c / Question 2 – b / Question 3 – d / Question 4 – b / Question 5 – c

REFERENCES

question 1

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 39 : DECEMBER 2014 / JANUARY 2015

15

Murine Eye Mist.

Refreshes dry eyes, naturally.

When you’re looking for an ‘eye mist’ you’ll see only one that is preservative free.

Introducing Murine Eye Mist, formulated to gently moisturise and refresh dry and tired eyes. The liposomes in Murine Eye Mist restore and stabilise the natural tear film to reduce moisture loss. It’s preservative free and can be used as often as needed to refresh dry and tired eyes. And it’s suitable for use with contact lenses and eye makeup.

Murine Eye Mist is available from your pharmacy. www.murine.com.au

Always read the label. Use only as directed. If symptoms persist, see your healthcare professional.

ANNOUNCING:

UP TO 2 FULL COURSES OF CHAMPIX IN 12 MONTHS FUNDED ON THE PBS 1

PLEASE REFER TO PBS SCHEDULE FOR FULL PRESCRIBING INFORMATION http://www.pbs.gov.au/pbs/home

1

PBS Information: This product is authority listed on the PBS as an aid for smoking cessation for adults. Refer to PBS schedule for full information.

BEFORE PRESCRIBING, PLEASE REVIEW FULL PRODUCT INFORMATION AVAILABLE AT WWW.PFIZER.COM.AU

CHAMPIX® (varenicline as tartrate) 0.5 mg and 1 mg Tablets. INDICATIONS: Aid to smoking cessation in adults (≥ 18 years). CONTRAINDICATIONS: Hypersensitivity to varenicline or excipients. PRECAUTIONS: Neuropsychiatric symptoms: history of or underlying psychiatric illness, including changes in behaviour or thinking, anxiety, psychosis, mood swings, agitation, hallucinations, aggression, depressed mood, suicidal ideation and suicidal behaviour; patients and families to monitor; patients to stop taking CHAMPIX at first sign of symptoms and contact a health care professional immediately; ongoing follow-up until resolution. Epilepsy, hypersensitivity reactions, cardiovascular events, driving or operating machinery, pregnancy, lactation, severe renal impairment. See PI for details. INTERACTIONS WITH OTHER MEDICINES: Nicotine replacement therapy. Theophylline, warfarin, insulin and CYP1A2 substrates (due to smoking cessation). ADVERSE EFFECTS: Smoking cessation/nicotine withdrawal symptoms. Most common: nausea, vomiting, diarrhoea, fatigue, insomnia, abnormal dreams, headache, constipation, flatulence, dry mouth, toothache*, dysgeusia, dizziness, arthralgia*, myalgia*, back pain*. Post-marketing reports of myocardial infarction, stroke, diabetes, hyperglycaemia. See PI for details. DOSAGE AND ADMINISTRATION: Patients should set a date to quit smoking and start taking Champix 1 to 2 weeks before this date.

Alternatively, patients begin Champix dosing and then quit smoking between days 8 and 35 of treatment. Days 1 to 3: 0.5 mg once daily. Days 4 to 7: 0.5 mg twice daily. Day 8 to end of treatment: 1 mg twice daily. Patients should be treated for 12 weeks. An additional 12 weeks of treatment can be considered for those who need additional support. Dose tapering is not required at end of treatment. Dose reduction is required for patients with severe renal impairment. See PI for details. References: 1. http://www.pbs.gov.au/pbs/home. 2. Mills EJ, et al. Annals of Medicine 2012; 44: 588-597 & Supplementary Tables. 3. CHAMPIX® Approved Product Information. Pfizer Australia Pty Ltd. ®Registered Trademark. Pfizer Australia Pty Limited. ABN 50 008 422 348. Pfizer Medical Information: 1800 675 229. 38–42 Wharf Road, West Ryde, NSW 2114. P9101 S&H 8/14 PFICH0966b-ITK-FP

*Please note changes to Product Information. V10114

18

Professional review

Healthy Weight

BY Margaret Robinson B.Pharm.Hons, Dip Comp Sci – AM Pharmacy Guild of Australia

OVERVIEW Overweight and obesity is now one of the biggest health problems facing Australians today. Obesity can lead to development of chronic diseases such as type 2 diabetes, high blood pressure and various cancers.

The obesity epidemic is not only affecting Australian adults, it is also affecting Australian children. It is being suggested by health practitioners that this generation of children may be the first to die before their parents of obesity related health problems.

This rapidly growing trend may be attributed to a couple of factors:

•• The over-availability of foods which are highly processed and contain large amounts of sugars and fats •• The sharp decline in levels of physical activity.

AUSTRALIAN STATISTICS How many Australians are overweight or obese?

In Australia, 60% of adults are considered overweight or obese.1 There have been significant increases in the proportions of overweight and obese Australians over the last 30 years.2 From 1980 to 2012, for people aged 25–64 years, the proportion of overweight women increased from 27% to 47%, and the proportion of overweight men increased from 47% to 66%.2 Men were more likely than women to be overweight, with 67% of men compared with 52% of women (aged 25 years and over) being overweight.2 More worryingly, 25% of Australian children are now classified as either overweight or obese.1 The Australian Longitudinal Study of Women’s Health, funded by the Australian

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 39 : DECEMBER 2014 / JANUARY 2015

Government, has been running for seventeen years and tracks 40,000 women in different age groups. The study has started to build up a comprehensive view of Australian women, their health and lifestyles with some interesting statistics so far:

•• Weight gain has been more marked and faster in younger than middle-aged women, with 33% of younger women being reported now as being overweight or obese – up from 20% in 1996.

•• Overweight, obesity and diabetes are increasing.

•• While fewer young women are smoking these days, few women get enough physical activity.

•• Only one in three women does enough exercise to qualify as sufficient for good health, while 10% of all women do no exercise at all.

Professional review

“The obesity epidemic is not only affecting Australian adults, it is also affecting Australian children.”

BMI and Waist Measurement1 Combining BMI and waist circumference to assess weight category and risk of diabetes and cardiovascular disease BMI (kg/m2)

Weight category

Waist circumference (cm) Men: 94–102 cm Women: 80–88 cm

<18.5

Underweight

-

-

18.5–24.9

Normal

-

Increased

25.0–29.9

Overweight

Increased

High

30.0–34.9

Obesity class I

High

Very high

35.0–39.9

Obesity class II

Very high

Extreme

>40

Obesity class III Extreme obesity

Extreme

Extreme

WHAT ARE THE RISKS?

DIETS

Being overweight is linked to many serious health conditions, including1: •• Type 2 diabetes •• High blood pressure •• Heart attack •• Stroke •• Gall stones •• Infertility •• Sleep apnoea •• Cancers (breast, colon, endometrium and oesophagus) •• Polycystic ovary disease

What is the best diet to lose weight?

WHAT IS CONSIDERED OVERWEIGHT? Body Mass Index The body mass index (BMI) is an internationally recognised standard for classifying overweight and obesity in adults.1,2 BMI is calculated by dividing the weight in kilograms by the square of the height in metres. Waist circumference is also a way of measuring overweight and obesity and is increasingly being used as a better measure of weight than the BMI.1,2

Waist circumference Waist circumference is one of the best ways to calculate health risks. Waist circumference is the distribution of body fat around the abdomen (the area between the ribs and pelvis or stomach area). Abdominal weight gain indicates that fat is stored immediately under the skin (subcutaneous fat) and probably around the organs in the abdomen (visceral fat) and is strongly connected with the risks of cardiovascular disease and type 2 diabetes.1,2

Men: >102 cm Women: >88 cm

A study published in the Journal of the American Medical Association looked at the impact of four popular diets – the Atkins (which advocates restricting carbohydrate intake), Weight Watchers (which advises portion control), the Zone (which advocates taking in foods with low glycaemic index), and the Ornish (which is a low fat diet recommending just 10% of total calorie intake from fat).4 After one year, weight loss on each of these diets was not dramatic and ranged from 3.9 kg on the Atkins diet to 6.6 kg on the Ornish low fat diet. All these diets were difficult to adhere to with at least half of the people in the studies dropping out of the study before completion. Long-term scientific studies have also echoed these results, concluding that low carbohydrate diets, low fat diets, low glycaemic index diets are difficult to adhere to and no dieting approach has any superior benefit over the other.4,5 The “best” diet to follow then is one that the patient can stick to, trying to follow the principles of good nutrition combined with exercise.

What are the tips from successful losers of weight?

The US National Weight Control Registry collates the nutrition and lifestyle habits of people who have been successful at taking weight off and sustaining the weight loss.6 Those on the registry successfully lost more than 13 kg for a year or more and sustained this weight loss. They mostly ate foods that

were high in carbohydrate content and fibre, and low in fat. They also ate breakfast every day, monitored their weight on a daily basis and became more physically active.

Only 1% of people on the registry followed a low carbohydrate diet, illustrating that this type of approach is not realistic for long-term weight loss.

Exercise Exercise is a vital part of any weight loss program. As a person loses weight, they will be losing both fat and muscle. Exercise enables a person to lose more fat than muscle, as the body will preserve its muscle because it is needed more than fat.

Even the ordinary or incidental movement that we do almost unconsciously throughout the day is now believed to be very important in adding to energy output. Thus, use of a simple device such as a pedometer is an effective way to track daily output of energy.

A goal of 10,000 steps in a day is now widely used as a marker of a moderate level of activity.7 It is now thought by some sources that the pedometer tracked goal of 10,000 steps per day is more effective in weight loss programs than the traditional “30 minutes of brisk activity per day”.7 Resistance or weight training is one of the most beneficial types of exercise.8 Muscles are very metabolically active tissues —in other words, they take a lot of energy to run, repair and maintain. As we age, we tend to lose muscle bulk so that it is harder to use energy and lose weight.

Weight training helps prevent muscle loss and builds muscle that has been lost.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 39 : DECEMBER 2014 / JANUARY 2015

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Professional review

TREATMENTS FOR WEIGHT LOSS Very low energy diets Very low energy diets are sometimes used in the extremely obese. These diets provide only 1700–3300 kj per day (about 600 calories).9 To achieve such a low kilojoule diet and still meet the body’s vitamin and mineral needs, a specialised liquid meal is used. These diets need the supervision of a medical practitioner and should only be used for a limited time, normally about four months. Interestingly, though weight loss with this treatment is dramatic (1.5–2.5 kg per week in obese people), the long-term weight loss success is not superior to conventional approaches to weight loss.9,10

Meal replacements Meal replacements are designed to replace one or more of the daily meals. They are produced in the form of shakes, bars or soups. They should not be substituted for the entire normal daily food intake. These products are usually very low in fat and often have added fibre. If used in conjunction with dietary changes, weight loss of 3–9.5 kg can be achieved over one to five years.11 When combined with counselling from a dietician, even better results have been obtained.11,12 These products appear to be safe and more effective than most other diet-based weight loss techniques;12 however, these products can be expensive.

POPULAR WEIGHT LOSS SUPPLEMENTS

PROPOSED METHOD OF ACTION

Caffeine/guarana Carnitine Chitosan Chromium picolinate Gingko biloba Grapeseed extract Lecithin Sweet clover St John’s wort

Increases metabolic rate Fat “metaboliser” Inhibits fat absorption Improves insulin sensitivity Stress reduction leading to reduced appetite Antioxidant – benefits circulation Increases transportation of fat Oestrogen-like properties – increases circulation Natural antidepressant may lead to reduced appetite

Weight loss supplements

Drug therapy

Because of the difficulty of weight loss, there are many supplements available over the counter, sometimes offering claims of quick and effective weight loss but without any scientific evidence for the validity of these claims. Many of these products also advise a reduction in energy intake and an increase in exercise which would explain any weight loss achieved with these supplements.

Orlistat, marketed in Australia as Xenical, is available over the counter13 and has been shown in supervised clinical trials to enable a person to lose 5–10% of their body weight over the period of one year’s usage.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 39 : DECEMBER 2014 / JANUARY 2015

Orlistat works by inhibiting the absorption of fat contained in foods. It stops enzymes in the gastrointestinal tract breaking down the fat in food so that it can be absorbed by the body. The fat is retained in the tract and excreted via the faeces. The action of Orlistat results in about a 30% reduction in the absorption of the fats in foods. However, if the person has a diet high in fat, the fats retained in the gastrointestinal tract can interact with bacteria in the bowel and cause unpleasant

Professional review

SELF-ASSESSMENT QUESTIONS

Orlistat has shown to have a greater potential for weight loss if patients follow healthy eating guidelines and increase their exercise capacity.

Orlistat is not supported by the Australian Pharmaeutical Benefits Scheme and this therapy may prove expensive if used consistently for over a year.

REFERENCES 1 Overweight and Obesity. Australian Institute of Health and Welfare. Australian Government.

2013. Available at (cited 1st Nov 2014): http://www.aihw.gov.au/overweight-and-obesity/ 2 SK Tanamas, DJ Magliano, B Lynch, et al. Ausdiab 2012. The Australian Diabetes Obesity and Lifestyle Study. Baker IDI Heart and Diabetes Institute;Melbourne:2013.

3 Mishra G, Loxton D, Anderson A, et al. Health and wellbeing of women aged 18 to 23 in 1996 and 2013. The Australian Longitudinal Study on Womens’ Health. Report prepared for the Australian Government Department of Health, May 2014.

4 Johnston BC, Kanters S, Bandayrel K et al.

Comparison of Weight Loss Among Named Diet Programs in Overweight and Obese Adults A Metaanalysis. JAMA. 2014;312(9):923–933 5 A recipe for trouble. Nature 2005;438:1052.

6 The National Weight Control Registry. Research findings. Available at (cited 1st Nov 2014): http:// www.nwcr.ws/ 7 Counting every step you take. Harvard Health Letter.

September 2009. Available at (cited 1st Nov 2014): http://www.health.harvard.edu/newsletters/ Harvard_Health_Letter/2009/September/countingevery-step-you-take 8 Wycherley TP1, Noakes M, Clifton PM, Cleanthous X, Keogh JB, Brinkworth GD. A high-protein diet with resistance exercise training improves weight loss and body composition in overweight and obese patients with type 2 diabetes. Diabetes Care.

2010;33(5):969–76.

9 Capstick F, Brooks BA, Burns CM, Zilkens RR, Steinbeck KS, Yue DK (May 1997). “Very low calorie diet (VLCD): a useful alternative in the treatment of the obese NIDDM patient”. Diabetes Res. Clin. Pract.

36 (2): 105–11.

10 Henry RR, Gumbiner B. Benefits and limitations of very-low-calorie diet therapy in obese NIDDM. Diabetes Care. 1991;14(9):802–23.

11 Kruschitz R, Wallner-Liebmann SJ, Lothaller H, et al. Evaluation of a meal replacement-based weight management program in primary care settings according to the actual European Clinical Practice Guidelines for the Management of Obesity in Adults.

Wien Klin Wochenschr.2014 Sep 6.

12 Dombrowski SU, Knittle K, Avenell A, Araújo-Soares V, Sniehotta F.Long Term Maintenance of Weight Loss With Non-surgical Interventions in Obese Adults. Systematic Review and Meta-analyses of Randomised Controlled Trials. BMJ 13 Product information Xenical. Roche Australia Pty Ltd. Dee Why NSW. 4th January 2012. Available at (cited 1st Nov 2014): http://www.roche-australia.com/ content/dam/internet/corporate/roche/en_AU/files/ miscellaneous/xenical-pi.pdf

QUESTION 1 You weigh and measure a man in the pharmacy. He is 170 cm tall and is 80 kg in weight.

What would he be classified as? a. Normal weight b. Overweight c. Obese d. Underweight

QUESTION 2 You ask if you can take his waist measurement. He is surprised and asks why you need to do this. You explain that: a. waist measurement is a better indicator than body mass index for overall body fat. b. together with the body mass index, it gives an indicator for the risk of cardiovascular disease via total body fat distribution. c. it indicates the amount of fat stored immediately under the skin (subcutaneous fat) and therefore around the organs and this is a better marker for cardiovascular risk than merely measuring body mass index. d. it is a better indicator for cardiovascular risk in men than women because men tend to put on more weight around the abdomen compared to women.

QUESTION 3 Orlistat: a. metabolises the fats in foods via its action on the liver. b. can cause abdominal adverse effects such as bloating due to non-absorbed fats in food interacting with gut bacteria. c. is currently the only available product available over the counter to aid weight loss. d. has been shown in clinical trials to result in a reduction of 30–40% in body weight over a period of one year.

QUESTION 4 Very low calorie diets: a. can result in dramatic weight losses of 1.5–2.5 kg per week sustainable over prolonged periods. b. have no place in weight loss programmes because of the difficulty in maintaining the body’s nutritional requirements at this low caloric level. c. can result in initial weight losses of 1.5–2.5kg per week. d. are designed for the extremely obese and should be used for only a few weeks.

QUESTION 5 One of the problems with weight management is that the patient tends to regain weight and the weight loss is therefore not sustainable. An American weight loss register of patients who have been able to sustain their weight loss recommend: a. having breakfast every day. b. following a low carbohydrate diet. c. weighing themselves regularly on a weekly basis. d. becoming involved in resistance training exercise programmes.

ANSWERS: Question 1 – b / Question 2 – c / Question 3 – b / Question 4 – c / Question 5 – a

adverse effects including bloating, flatulence and an unpleasant oily diarrhoea. Patients should be encouraged to limit their intake of fatty foods and realise that if they have a “binge” breakout and eat a fatty meal that there could be unpleasant consequences of gastrointestinal adverse effects.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 39 : DECEMBER 2014 / JANUARY 2015

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GLUCOJEL MEANS BUSINESS

AND IT IS MADE IN AUSTRALIA

Still in the top ten when it comes to over-thecounter pharmacy sales, and in pharmacy only.

And that means good business for you.

Order from your preferred wholesaler: PRODUCT

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594326

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698229

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Extra Strong Mints x 24

618934

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or contact Gold Cross Products and Services for product enquiries.

T 02 6270 8950 F 02 6270 8999 enquiries@goldx.com.au

What can Tony Ferguson do for your TOTALLY NEW! Pharmacy?

Growing pressure on dispensary means that now is the best time to be looking for options to:

✓ Increase front of shop sales and margins ✓ Expand your range of professional services ✓ Attract New Customers Tony Ferguson is an iconic weight loss program that is being relaunched for 2014. The key changes to the program are:

✓ Completely redesigned program, based on the latest Australian Dietary Guidelines

✓ Renewed focus on Consulting ✓ Expanded Product Range ✓ National Relaunch Advertising Campaign ✓ Backed by Terry White Chemists and Symbion Terry White Chemists automatically qualify to have a Tony Ferguson Weight Loss Clinic in their store, but they are also available in limited numbers, in certain locations, to independent pharmacies too.

To enquire about becoming a Terry White Chemist franchisee, call (07) 3238 0222.

To see if your independent pharmacy qualifies for a Tony Ferguson Clinic, contact Julie-Ann Wharley on 0410 417 135.

For more information about the new Tony Ferguson Program go to tonyferguson.com

24

DOWN TO BUSINESS

So, what’s the plan?

Peter Saccasan FACP FCA CTA Director of Pharmacy Services, RSM Bird Cameron Chartered Accountants

The environment for successful small businesses has never looked better. Low interest rates continue unabated and the short- to medium-term outlook, they tell me, is that there is more of the same (disclaimer – I am not a finance market specialist, so you are on your own with this one).

“Strategic planning, budgets and cash flows don’t often appear on the business owner’s all-time favourite reading list, but I think that needs to change quickly.”

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 39 : DECEMBER 2014 / JANUARY 2015

DOWN TO BUSINESS

The employment market seems to be a “buyer’s market”, i.e. those buying labour – employers – are price makers not price takers. So life couldn’t be better for pharmacy owners, right? I am not sure I see too many heads nodding in agreement. Whilst pharmacy seems to have dodged a bullet on the competition review outcomes (according to reported political allegiances), the sleeping giant of PBS reform continues to run rampant. Pharmacy owners, in the main, continue to maintain the “it’s a tough game” outlook and seem to be lost as to where to start to stem the tide. It almost appears as though owners can’t take a step back, look at the entirety of their business, and make some important key decisions.

Strategic planning, budgets and cash flows don’t often appear on the business owner’s all-time favourite reading list, but I think that needs to change quickly. Successful change management is not complicated.

It takes focus and commitment and that mainly stems from one person – the owner. The owner is certainly not expected to do this all on their own; however, the team will take their lead from the owner. If you think it is all too hard, won’t change habits, and don’t walk the talk, then the changes won’t stick.

I am presently working with a number of owners to achieve change in 3 steps – review, plan, act. And then start again – review, plan, act. The change management process, in my view, merely requires commitment.

Can anything else possibly go wrong?

A review of your business performance, at a reasonable level of depth, will quickly highlight areas that can be improved.

The historical high gross profit margins of the past 2 years have done a terrific job of hiding a few issues. Of the 350 lineal metres of stock in your store, probably 50% of it is

“Successful change management is not complicated. It takes focus and commitment and that mainly stems from one person – the owner.”

performing at a questionable level, your script growth is just inching along, stock turn is low, and in some categories abysmal, and your landlord thinks life is just dandy as the usual unaffordable rent increase has just come in the mail. And to cap it all off, your bank loan, which was borrowed at 75% of your business value, has been interest only for 2 years and is now heading to a principle reduction mode.

The strategic planning will identify just what is broken and where you need to act.

The planning takes time and demands action.

As you work through the issues outlined in the previous paragraph, each area will create some goals to be achieved and each goal will need thinking through. What strategies will you employ in achieving these goals? This needs good thinking time. You generally know your customers – or do you? Have you, say, asked them why they come to your pharmacy?

Or, how many other pharmacies they include in their regular shop? – and yes, they will have another. And then you need to take some positive actions as a result of their answers.

As the strategies unfold, you can then simply list the actions you need to take to get things right and moving again. And you need three more things – a timeline, a KPI you can measure that will tell you how you are going, and lastly – a name attached to the action as to who will make it happen!

I can really do this right?

As owners move through this simple process, there are generally lots of nods of heads.

Yes, we get it, and why haven’t we been doing this before? The answer is generally because the action from the 30m2 space called the dispensary has been too good to resist. But the gloss has gone off the relationship now and a new interest is being sought.

•• the cash you need to implement the plan •• the cash you won’t have if you do nothing.

And, again I will say, it’s not hard, it just needs commitment – from you.

The initial planning and review phase can be a grind because it is taking owners into an area of management that they might not usually spend too much time. And we ask some very direct questions like – do you really need to take that much money out of the business? From there it’s a matter of sticking to the plan, keeping track of where it is up to and measuring the impact of the changes as they are made. With the right systems in place, the tracking can take place in store and all you need is someone to check in with you to make sure it’s happening. We find that a regular check-in, combined with a quarterly review, usually keeps the process moving.

Some great by-products The beauty of doing something with intent is that often other advantages, apart from what you were aiming for, can flow. By taking an enquiring mind to your business position and future, plans evolve on how to grow the business and, with such specific plans to hand, this means the marketing program and budget can actually be tied to real outcomes. Having a marketing program that is focused on just a few departments, might prove to be more beneficial than the usual catch-all catalogue programme.

By making a good assessment of the business cash flow, you will actually be forewarned of any possible overruns against available capital. And this means you can plan the solution in advance rather than on the phone when your bank manager calls you.

A strategic plan will set out:

•• the way you will attack dispensary growth •• how you will improve your retail performance

•• professional services that are relevant to your customers and your offer •• what you can do to curtail your costs •• when you will need to break open the negotiations on that expense premise lease

So take the next step and – 1 Undertake a review of your pharmacy 2 Determine your strategic plan, and then 3 Act!

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 39 : DECEMBER 2014 / JANUARY 2015

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26

down to business

Guild Pharmacy Academy update!

Impress your customers with value added services

Strategies to sustain customer loyalty, improve To subscribe updates TRAINING GUILDtoINTERN foot traffic and increase the number of items per sale are hot topics in pharmacy these days from the Academy and be as these measures can help buffer the effects one of the first pharmacies of PBS reform and increased competition.

Showcasing the expertise of pharmacy staff to access these courses, has been demonstrated as an effective simply enrol your staff measure to standing out in a crowded market. in the Guild’s online More than ever before Australian pharmacies are embracing their service offering learning platforms myCPD and adding value to the customers’ in store (for pharmacists) and experience. Maternal health, bone health and travel health services are just a few of the niche myLEARNING (for pharmacy Guild interns make the best interns because they have access by to:pharmacy to attract new areas being explored assistants) via our website • A program balanced with clinical and business knowledge customers and ensure they keep their current customer base coming back. As our approach to • Comprehensive exam preparation www.guild.org.au/academy pharmacy services evolves, however, so do the

• Visits from a clinical tutor providing on-site assistance and mentoring

from conception to implementation is no simple task. Successful implementation of a new service not only relies on well-trained Thanks Lindaalso and Jenny from staff,tobut adequate planning and Werrington Pharmacy NSW for participating in thefor photography strategies ongoing evaluation and review.

One factor that is often overlooked is the reality that creating change in any workplace has the potential to ruffle feathers. As such, an understanding of the principles of change management can also be vital.

In the first half of 2015, the Guild Pharmacy Academy will be releasing a suite of online training courses to assist pharmacies to provide value added services. These courses will address the following:

•• Taking care of your top 100 customers •• Setting up in-store pharmacy services

training needs of pharmacy staff.

• Training in the latest professional programs and services under the

The Guild Pharmacy Academy recognises

5th Community Pharmacy Agreement that carrying an idea for a pharmacy service To find out more visit our website or call your local Guild branch.

•• Maximising your Pharmacy Only and Pharmacist Only Medicines

New free courses from the Guild Pharmacy Academy

www.guild.org.au/academy

A pharmacy assistant’s guide to managing cough – Bisolvon

Fabfol – supplementation in pregnancy

Are you ready for QCPP A guide to supplementation NSW & ACT - 02 9467 7124 / QLD - 07 3831 3788 / TAS - 03 6220 2955 / WA - 08in9429 4100 and a product accreditation? pregnancy, guide to Fabfol, for pharmacy New free online QCPP Refresher assistants.

Training available for pharmacy assistants at myLEARNING

Available at myLEARNING

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 39 : DECEMBER 2014 / JANUARY 2015

Management of anal fissures A comprehensive pharmacist CPD course on the management of anal fissures.

Available at myCPD

1

Stop smoking aid. Contains nicotine.

1. Du D et al. Journal of Smoking Cessation 2014;doi:10.1017/jsc.2014.5 (GSK sponsored) NICABATE is a registered trade mark of the GSK group of companies.

GlaxoSmithKline Consumer Healthcare, 82 Hughes Avenue, Ermington NSW 2115.

CHANZ/CHNIC/0204/14

28

Professional Review

Mind-altering microbes “Good” gut bacteria and the brain

BY JO ANDREWS BSc (ChemEng), BHlthSc (CompMed)

The gastrointestinal tract contributes to health in numerous ways, many of which are not restricted to digestion and absorption of food. Bacteria inhabiting this tract amount to ten times more cells than in our bodies and this microbiome plays an important role in human physiology. Current research is focussing on the function these bacteria have in the normal regulation of brain chemistry and behaviours that are relevant to mood. Evidence is mounting that an individual’s microbiota composition influences their susceptibility to anxiety and depression.

The Human Microbiome •• The Human Microbiome Project has increased awareness of the role of the microbiota in health and disease.

•• There are 150 times as many genes in the microbiome as in our genome

•• There is a critical window early in life in which the colonisation of the gut must occur to ensure the normal development of the nervous system.

•• Each individual has their own The relationship between gut bacteria and the human host goes far beyond the simple understanding that they are “good” or “bad” for us. Gut bacteria affect the speed that our foods are digested, the efficiency of our nutrient absorption and the strength and integrity of the intestinal barrier.

They play a crucial role in the establishment and function of our immune system, in the development of obesity and in the distribution of body fat. What is also clear is that gut bacteria communicate with the central nervous system in a two-way conversation: microbiota influence nervous function and the nervous system influences the bacterial composition.

This microbiota-gut-brain axis is emerging as an important factor in the regulation of cognition and pain and in the development

of stress-related psychiatric disorders such as anxiety and mood. Research studies have shown alterations in gut bacterial composition in individuals diagnosed with depression.

Inflammation How bacteria influence brain function is not yet fully understood. Most probably, microbiota modulate the stress response and stress-related behaviours. Research shows that exposure to repeated stress affects the composition of the microbiota in a way that is closely correlated with a heightened inflammatory response. Brain function can be directly affected by alterations in levels of pro-and anti-inflammatory mediators in the blood stream. Stress can also damage the intestinal lining allowing bacteria and partially

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 39 : DECEMBER 2014 / JANUARY 2015

microbiome profile

•• Chronic stress effects the composition of the gut microbiota

•• Antibiotic medications alter the microbiome profile, particularly with long-term use and in the treatment of childhood illness

•• Concentrations of the microbiota are influenced by food intake (amongst other factors)

•• Concentrations also change through the life stages.

•• The elderly have distinct microbiota and age is accompanied by a marked decrease in the ability to cope with a variety of stressors as well as a progressive increase in a pro-inflammatory state

Professional Review

Probiotics •• Are live organisms that exert a health benefit on the host

•• Must be consumed in sufficient quantities to be effective

•• Are used successfully in treatments of many conditions including: – gastrointestinal disorders such as IBS – long-term conditions such as chronic fatigue syndrome and eczema – stress and anxiety disorders – pain and inflammation

•• Different strains exert different effects on the body

•• Many strains are commercially available and the choice can be overwhelming •• Care must be taken in choosing the right one for your health

digested food to enter into circulation which further increases systemic inflammation.

The Role of Probiotics: These effects can be reversed by probiotics. For example, Lactibacillus farciminis and Saccharomyces boulardii (both commercially available) can reduce intestinal permeability and decrease inflammatory load.

Chemical signals Pathogenic bacteria (commonly known as “bad” bacteria) are able to influence a person’s behaviour by directly invading the nervous system. In contrast, non-infectious bacteria impact brain function through their ability to synthesise many neurotransmitters and neuromodulators. Gut microbiota may signal to the brain through multiple routes including nerve pathways and the bloodstream.

In many instances of clinical depression, neurotransmission is disrupted and mood regulating neurotransmitters fail to function normally. Brain signals can be depleted or fail to move onto the next nerve cell.

“Brain function can be directly affected by alterations in levels of pro-and antiinflammatory mediators in the blood stream.”

The Role of Probiotics: Colonisation by pathogenic bacteria is prevented and certain bacteria (B. infantis is one) exert anti-depressive effects and stabilize mood.

Brain fatty acids Certain omega-6 and omega-3 fatty acids play important roles in brain development, structure and function. They can alter nerve transmission and protect the tissue against oxidative stress.

Fatty acid concentrations in the brain influence anxiety, depression, learning and memory.

The Role of Probiotics: Certain strains of B. breve for example increase the concentrations of fatty acids beneficial to normal brain function structure and function, reducing inflammation and elevating mood.

It is becoming increasingly clear that the gut bacteria can affect an individual’s neurochemistry, neurobiology and their behaviour in a variety of ways. By return communication via the microbe-gut-brain-axis, we also know that stressors have an effect on bacterial composition.

We are able to deliberately manipulate the microbiota with foods and drugs, and we can colonise the gastrointestinal tract with microbes of choice. Including probiotics in the treatment of anxiety and depression is proving to be effective in many cases particularly where gut health is impaired. The future for microbial-based therapeutics as alternatives for these mood disorders looks promising.

References 1 Cryan JF, Dinan TG. Mind-altering microorganisms: the impact of the gut microbiota on brain and behaviour. Nature reviews Neuroscience. 2012;13(10):701-12.

2 Lyte M. Microbial endocrinology in the microbiome-gut-brain axis: how bacterial production and utilization of neurochemicals influence behavior. PLoS pathogens.

2013;9(11):e1003726.

3 Maes M, Berk M, Goehler L, Song C, Anderson G, Galecki P, et al. Depression and sickness behavior are Janus-faced responses to shared inflammatory pathways.

BMC medicine. 2012;10:66.

4 Sarris, J. & Wardle, J. Clinical Naturopathy An evidence-based guide to practice 2ed. Chatswood: Elsevier; 2014.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 39 : DECEMBER 2014 / JANUARY 2015

29

SIZE

API PDE

SYMBION PDE

SIGMA PDE

RRP

MIN QTY

Gold Cross Chesty Cough Relief

200mL

615730

397318

154112

$10.99

3

Gold Cross Dry, Tickly Cough Relief

200mL

615722

397334

154120

$10.99

3

Gold Cross Pholcodine Linctus

100mL

434035

101485

299289

$5.99

3

Gold Cross Senega & Ammonia Cherry

200mL

304913

101498

868851

$4.99

3

Gold Cross Senega & Ammonia

200mL

734276

101489

179200

$4.99

3

Gold Cross Senega & Ammonia

500mL

244740

101497

791806

$8.99

3

NAME

TOTAL

QTY

32

RETAIL FOCUS

Tying it all Together!

“Without your full commitment to ALL of the strategies, you will not maximise the full potential of your business and by “full commitment” I mean every minute of every day.”

BY SIMON HAMBRECHT Director of Pharmacy Essentials

What a year it has been. So much change in so many areas – something our industry struggles to come to terms with. Historically our industry has been slow to accept change and now, in the modern era, as we move into a more retail orientated business model we need to be so much more dynamic – accepting & adapting to changes at a moment’s notice. That’s retail!

Change, change, change.

So far this year I have given you some guidance in a number of areas where you, as owners and managers, need to increase your level of confidence. To date, we have covered:

•• Maximising your Dispensary opportunities: – Using script trade to drive retail sales – Getting yourself, and your other Pharmacists, out the front, engaging with customers & selling – Restructuring the staffing of your Dispensary with Technicians – freeing the Pharmacist up – Utilising the “Pharmacist recommendation”

•• Having tighter controls in place: – Testing & measuring all initiatives – Using budgeting to increase accountabilities around stock

So which of these tools are the most important? Well, there is not one that is more important than the others.

In fact, you will only achieve better performance by using them all.

There is one element we haven’t yet covered and it is what you need to do to bring everything we have spoken about this year together – commitment.

Without your full commitment to ALL of the strategies, you will not maximise the full potential of your business and by “full commitment” I mean every minute of every day.

You have to lead from the top down and drive performance.

– Emphasising the need for tighter stock control

•• Measuring Team performance: – Achieving a return on investment for wages – Using Team and individual targets to achieve goals – Maximising your Team’s performance

•• Appraisals: – Communicating Team performance effectively – Gaining a better understanding of what matters to your Team – Using appraisals to establish expectations

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 39 : DECEMBER 2014 / JANUARY 2015

This means embracing what is required for implementing each of the processes and following every step of each process. Further, it means freeing yourself up and getting out on the floor, working with each of your Team and ensuring they are following through on your expectations of them.

You need to be taking the time to observe what is happening in your business. By this I mean looking over your sales figures, setting your KPI’s and reviewing the progress of them, as well as watching how your Team Members are interacting with your customers to maximise your sales.

RETAIL FOCUS

When was the last time you stood in a quiet area of your pharmacy and counted how many of your customers left empty-handed?

Every one of these is a missed opportunity resulting in reduced revenue. It’s these missed opportunities which need to be addressed as it affects the sustainability of your business.

All of the elements we have covered this year may seem daunting as you may not have had to undertake them in the past. Through commitment, you will gain an understanding of each element more quickly and learn how to tie them all together.

We appreciate, there will be days where you become frustrated and it will not seem to be worth all the hassle. It may be one element, all of them combined, or you may feel like you’ve hit the “ceiling of performance” and can’t achieve anymore.

This is when your level of commitment will be tested and you need to remain focused on continual improvement. There is no such thing as a “ceiling” when it comes to the

performance of your business. If you remain committed and continually strive to be better, you will always achieve a better result.

Ongoing commitment is the key and through it you’re able to tie all the processes we have spoken about together.

As this is my last column for the year, I would like to leave you with two thoughtprovoking ideas. The first of these relates to your Dispensaries: As an industry, if we don’t stop relying on PBS revenue, we will forever be at the mercy of the Federal Government – continuing to force you to jump through whatever hoops they need you to.

The second of my ideas is in two parts and relates to your retail sales:

33

and effort into growing my retail sales, what would my business look like?”

Can I tell you, the answer to the second part would be a reversal in the split of your business where retail would be where a majority of your revenue comes from? Further to this, we would not need to rely on the Federal Government for subsidised revenue.

I can think of one group who has already adopted these ideas – the largest and most aggressive group in the country. I wonder how long it would take the rest of the industry to catch up.

I hope you, and your Teams, have a great and safe Christmas and New Year. May sales be strong and I look forward to writing for you in 2015!

1. Think of how much energy and effort you put in when it was evident we needed to increase generic conversion to maintain profits in the Dispensary.

2. After you have an idea of this, ask yourself, “If I dedicated the same amount of energy

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Always read the label. Use only as directed.

If symptoms persist consult your healthcare professional.

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Pain that won’t go away may be nerve pain.

It’s a different kind of pain that needs different pain management.

Patients may describe their nerve pain as:1

ELECTRIC SHOCKS

BURNING

FREEZING OR NUMBING

SHARP OR STABBING

PINS AND NEEDLES

Patients can go to nervepain.com.au for more information.

Reference: 1. Freynhagen R, Bennett MI. BMJ. 2009; 339: 391-395. Pfizer Australia Pty Ltd. ABN 50 008 422 348. 38-42 Wharf Road, West Ryde, NSW 2114. Medical Information: 1800 675 229. ®Registered trademark. P7589 S&H 11/14 PFILY0971-ITK-A4-L

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down to business

The Secret To Making Your Pharmacy Successful All Year Round BY vanessa lontos The Care Project – Helping build health and wellness services in your pharmacy.

December is a great time of the year, the weather is warmer, the excitement of the festive season is building, another year is coming to an end and the possibilities of new beginnings are presenting themselves. Pharmacies are generally a hive of activity, with customers collecting more of their medicines to take on holidays and often doing some extra shopping. Recently I was speaking with a pharmacy owner and friend, about pharmacy success through patient engagement and she said “I wish I could generate the vibe of December all year round – it’s all hands on deck”. This inspired my thinking around opportunities for success in pharmacy and where they lie. The December Buzz is a key success strategy.

“The December Buzz is that feeling your customers get when they walk into the store and everything seems to flow... What are 3 secrets you can learn from December that can be applied to the rest of the year to make your pharmacy even more successful?”

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 39 : DECEMBER 2014 / JANUARY 2015

The December Buzz is that feeling your customers get when they walk into the store and everything seems to flow. They get a wonderful experience and everyone that serves them is warm, friendly and makes them feel important. There is a connectedness between all the staff that shows that they care about their work and each other.

This ‘all hands on deck’ approach and the days, while busy, feel rewarding and fun.

What are 3 secrets you can learn from December that can be applied to the rest of the year to make your pharmacy even more successful?

down to business

1

Every customer is a gift every time they visit

When I bought my pharmacy business I took over 12 days before Christmas. It was such a busy time and such a steep learning curve.

I felt like I was a student again – I knew nothing and I knew no one.

However, one of the most profound lessons I did learn was during those first 2 weeks, and that was the importance of connecting with everyone that walked through the door. Acknowledging them in a unique and personal way and recognising them as a gift to the business I had just bought. They had chosen our pharmacy for their health needs and I was so grateful.

While many of these customers had been visiting the pharmacy for years, to me they were all new. How can you acknowledge all your customers each day for the gift that they are to the business?

2

Focus on celebration

We underestimate the power of celebration.

Too often we tend to only celebrate when there is a ‘legitimate’ time to celebrate, be it birthdays, reaching a goal or going on a holiday. We have many things to be thankful for every day yet we tend to focus often on what is yet to be done, what was missed, what opportunity was lost and what the till reports show.

Each day brings the opportunity to celebrate. Just opening the doors and having people choose to visit your pharmacy is an opportunity to celebrate. Forming friendships with your customers and celebrating their health wins is another way of building celebration into your days.

There is always time to celebrate – the key is in focusing on it.

“Help your staff feel happy, acknowledged and energised all year and keep the feeling of the December buzz all year round.”

3

Keep yourself fresh and energetic

The end of the year often brings the opportunity to reflect upon your own performance, energy levels and health.

Many people feel burnout toward the end of the year but feel an injection of enthusiasm knowing that time with family and friends, holidays and fun times are ahead.

It’s important to speckle your year with enjoyable and energy-lifting activities.

Create a calendar of activities for the year to ‘re-charge and re-boot’ yourself and your teams, for example maybe plan a weekend retreat, arrange regular dinners, form a walking group.

Taking care of yourself during each shift is very important as it is the little things that happen daily that tend to chip away at your energy tank.

Help your staff feel happy, acknowledged and energised all year and keep the feeling of the December buzz all year round.

Finally, while all businesses go through peaks and troughs, the most successful are those that create happy and enjoyable workplaces for their staff and consistently remarkable experiences for their customers.

Consistency is the cornerstone of success – remember December all year round.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 39 : DECEMBER 2014 / JANUARY 2015

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down to business

Christmas and the New Year A time for celebration, overindulgence and...resolutions?

Jane Larter Professional Practice Pharmacist

I always have found there are two aspects in the lead up to Christmas and New Year: one is the excitement and knowledge that I will get to spend some quality time with family and friends; the other is “here we go again” referring to the hectic, manic time that is pharmacy at this time!

When I was a child, everything would close over the Christmas period and I swear it was like the world was going to end with how we had to prepare for this – for example, going grocery shopping and getting enough food to survive 3 days! In the past few years of course, this is not the case as everything stays open, but people still think the sky is falling at this time and they need to prepare.

One thing you can help your customers with over the lead up to Christmas is helping

them remember (or get them to realise) what they will need over the Christmas break.

Questions such as “Are you travelling over Christmas?” and “Have you considered how much medication you will require?” are a great reminder to our customers to plan ahead.

Also, reminding those customers of your pharmacy’s open hours over that time period will help them in their planning. Why not create a small flyer that can be handed out with purchased items advertising these hours

(and for good measure the professional services you offer)?

Of course, once the busy-ness of Christmas is over people like to start the New Year fresh and ready for change. This mind frame may not last long, but once they mention their New Year resolution to us (the two biggest here usually being to quit smoking or to lose weight) that is where we can shine and show our expertise in the area!

A basic formula to prepare for customers enquiring about these categories could be: 1. Have your first staff training of the New Year on smoking cessation and weight loss.

To brush up on your knowledge of smoking cessation, and to help plan a training session around this category, have a read of this month’s ITK CPD article ‘It’s Quittin’ Time! Smoking Cessation Strategies for Pharmacists’ p. 10.

A person considering going on a diet and getting their weight under control would go through similar stages as someone who wishes to quit smoking (pre-contemplation, contemplation, preparation, action and maintenance). Like smoking cessation, pharmacists are in an ideal position to provide advice on weight management strategies, and encourage and assist people to adopt healthy behaviours. This involves a team approach where pharmacists collaborate with individuals and other health care professionals (e.g. dietician) to identify and achieve appropriate weight management goals.

2. Consider your companion sales! Know what other products can assist your customers and other bits of information you’ve heard work for others.

I had a customer once who had quit smoking about 10 years previously. She said she did so cold turkey as it was more the habit of smoking than the actual cigarettes she craved. She and her friend therefore used to cut up carrot sticks (same length and size as a cigarette) and any time she felt like a smoke she would just grab a carrot stick and eat that instead.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 39 : DECEMBER 2014 / JANUARY 2015

down to business

3. Offer professional services/programs for your customers to join e.g. your pharmacy’s weight loss program/smoking cessation program or advise them of any healthy eating/living programs in your community area.

Check out http://www.healthylivingnetwork.com.au/ – it’s a free directory letting people know of the services in their district.

4. Offer lifestyle advice not just product advice.

All customers could be counselled on healthy eating and physical activity. Think of your customer’s age and medical conditions before recommending hard-core exercise – don’t tell a 65-year-old woman who has osteoarthritis that to lose weight she will have to do 5km runs 5 times a week!

There are some amazing websites to assist with this information; however, the best that I have come across is http://www.healthwaysaustralia.com.au/gethealthy. It is a free, confidential telephone service funded by the Government that helps people make lifestyle changes in relation to healthy eating, exercise, and achieving a healthy weight.

Think Quitline, but for weight and exercise instead of smoking cessation.

“One thing you can help your customers with over the lead up to Christmas is helping them remember (or get them to realise) what they will need over the Christmas break.”

5. Do your customers have a smartphone? Get them to try some of the wonderful FREE apps available to them!

For example myQuitBuddy for smoking cessation; myFitness Pal or food Switch for wise food choices; and MapMyFitness, C25K or Bupa fitness to name only a few of the many exercise apps out there.

Remember these customers are coming in to your pharmacy for your advice! They’ve probably seen the Discover More. Ask Your Pharmacist adverts.

Help them set their goals and encourage them to achieve and maintain them so that next New Year they’re going to have to think of completely different resolutions.

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Pain scores at rest: (mm VAS score)

Maxigesic 速 Ibuprofen# Paracetamol#

DOUBLE ACTION

50 45 40 35 30 25 20 15 10 5 0 0

4

8 12 16 20 24 28 32 36 40 44 48 Hours post-surgery

# Ibuprofen 1200mg/day or Paracetamol 4000mg/day in 4 divided doses.

Ref 1

DOUBLE ACTION

training and education

The Totally New Tony Ferguson Weight Loss Program

Weight Loss for Life Tony Ferguson is one of Australia’s leading weight loss brands that has helped nearly 1 million people lose weight and lead healthier lives. Developed by pharmacist, Tony Ferguson, the Tony Ferguson Program incorporated meal replacements and customer support to help people lose weight. Now after nearly 10 years, the Tony Ferguson program has had a major review and restructure of its company, team and program.

Tony Ferguson believe weight loss programs should be based on current evidence, so have developed a new program influenced by the latest weight loss thinking1 and Australian Dietary Guidelines2. This is to ensure its members are receiving the best possible advice and support on their weight loss journey.

The Obesity Epidemic is Getting Worse Over 60% of Australian adults are overweight or obese and this number is steadily rising. Tony Ferguson satisfies the need for a supportive weight loss program that aims for slow, steady weight loss that is realistic and transitions into successful long-term weight management.

What is the new Tony Ferguson Program?

The new program is a structured, support based weight loss program that is influenced by the Australian guidelines for nutrition and weight management set by the Australian Government. The program supports and educates its members through:

•• Weekly consultations with trained consultants

•• Education on the five food groups and •• •• •• ••

portion control Addressing hunger Personalised meal plans New, improved meal replacements and an expanded food range A private and easily accessible environment in a pharmacy based Tony Ferguson Weight Loss Clinic

What makes the Tony Ferguson Program different?

Is Tony Ferguson Suitable for Everyone?

Quick fix, off-the-shelf weight loss programs don’t work. At Tony Ferguson, we believe it is important to provide credible, evidence based information, encouragement and support to our members to assist in successful, healthy, sustainable weight loss.

The new Tony Ferguson Program is for anyone over the age of 18 looking to lose weight and keep it off for life. The program is suitable for both men and women who are generally healthy (anyone with a specific medical condition should discuss their situation with a Tony Ferguson consultant to see if the program is right for them). Women who are currently pregnant or breastfeeding are not suitable to join the program.

The new Tony Ferguson Program is delivered over a series of compulsory consultations to ensure members have the time to learn and understand the key principles of successful weight loss and make small but realistic adjustments to their lifestyle. The first 5 weeks on the program set the foundation of knowledge needed, and covers important topics such as:

•• •• •• •• •• ••

Gauging and addressing hunger Making healthy meals Involving the household Healthy supermarket shopping Eating out and socialising Exercise

After 5 weeks, members have access to a large range of further topics as part of their personalised program.

We differ from many off-the-shelf weight loss products as we understand most people find weight loss hard, and everyone’s weight loss journey is different. So it’s critical that our members feel supported and their consultant understands any challenges and how to overcome them. The program also acknowledges that there are many benefits of changing to a healthier lifestyle – weight loss being just one of them.

(Endnotes) 1 Clinical Practice Guidelines for the Management of Overweight and Obesity in Adults, Adolescents and Children in Australia (2013) (NHMRC) 2 Australian Dietary Guidelines 2013 (NHMRC)

It doesn’t matter if a member has a lot of weight to lose, or a little. The program is suitable for individuals looking for a supportive program.

What is the Role of Tony Ferguson Consultants?

The Tony Ferguson Program is a pharmacy-only weight loss program which is delivered by trained Tony Ferguson Consultants. The best Tony Ferguson consultants are typically highly valued pharmacy staff who are passionate about health and helping others. Consultants receive detailed training from Tony Ferguson which provides them with additional skills to help, coach and support members to achieve their weight loss goals.

To reflect, Tony Ferguson’s status is a ‘consultation-only’ program, as many of the new Tony Ferguson products are only available via appointment with a trained consultant.

You can find more information on the new Tony Ferguson Program at www.tonyferguson.com. If you would like to discuss having a Tony Ferguson Weight Loss Clinic in your pharmacy, contact one of our State Managers by calling 1800 612 644.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 39 : DECEMBER 2014 / JANUARY 2015

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TRAINING AND EDUCATION

A Little Bit of Relief Natural pain relief in a cooling gel A Little Bit of Relief is a 100% Australian owned & made pain relief gel, formulated from natural active ingredients for the temporary relief of:

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A Little Bit of Relief Tube 100g This handy tube is perfect for carrying in a bag or when travelling. Great for active people on the go.

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People all over Australia are turning to A Little Bit of Relief.

A Little Bit of Relief uses natural active ingredients, including eucalyptus and peppermint oils. These act as effective analgesics and anti-inflammatories to temporarily ease pain and reduce swelling, without the unwanted side effects of many other medications.

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A Little Bit of Relief has been formulated to be suitable for long term use, such as for the management of chronic pain.

AUSTRALIAN OWNED A Little Bit of Relief is 100% Australian owned, and proudly Australian made.

A Little Bit of Relief Pump 150ml An easy, quick dispenser for the home or at work. Perfect for keeping on a desk or in a cupboard.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 39 : DECEMBER 2014 / JANUARY 2015

Visit alittlebitofrelief.com for more information.

For pharmacy orders, contact Clear Sales Australia on 1800 640 043 or order direct from Symbion, Sigma or API.

TRAINING AND EDUCATION

Cromo-fresh® eye drops PRESERVATIVE-FREE TREATMENT FOR ALLERGIC EYES - NOW IN A BOTTLE 1.0 Indications Q. What is CROMO-FRESH used for? ®

A. CROMO-FRESH® eye drops (sodium cromoglycate 2% w/v, 10mL bottle) are used for the prevention and treatment of allergic eye conditions such as hayfever, allergic conjunctivitis and vernal keratoconjunctivitis. These conditions can cause itching, redness, discomfort and watery discharge from the eyes.

2.0 Mode of Action Q. How does CROMO-FRESH® work?

A. CROMO-FRESH® is not an antihistamine treatment – it stabilises the mast cell membrane and inhibits the release of histamine and other inflammatory substances in the eye. Using CROMOFRESH® for about a week before the onset of the expected allergy season may help reduce the symptoms associated with eye allergies.

3.0 Precautions/ Contraindications/Interactions Q. Are there any patients who would not benefit from CROMO-FRESH®, e.g. children?

A. CROMO-FRESH is suitable for use by both adults and children, but patients who are allergic to any of the ingredients in CROMO-FRESH® should not use it. ®

Q. Is CROMO-FRESH® suitable for use with contact lenses?

A. Soft contact lenses should not be worn while using CROMO-FRESH® eye drops, as it is not usual to wear soft contact lenses while being treated for allergic conjunctivitis. However if patients continue

to wear hard contact lenses while being treated, they should remove the lenses before using the eye drops and not reinsert them for at least 15 minutes after use.

4.0 Side Effects Q. Are there any side effects to be aware of, or is CROMO-FRESH® well tolerated?

A. CROMO-FRESH® is preservative-free so is usually well tolerated, but it may have some side effects. Patients should stop using and tell their doctor or pharmacist if they suffer from eye irritation, blurred vision or temporary burning/stinging after application.

6.0 Counselling Points Q. How do you use CROMO-FRESH®?

A. The usual dose is 1-2 drops into the affected eye(s), 4-6 times daily. Patients should prime each bottle before first use by pressing down on the base until the first drop appears.

Q. Why is a preservative-free treatment for allergic eyes beneficial?

A. The use of preservatives in eye solutions may result in the following:

•• Allergising effects •• Cytotoxicity •• Increase the wash-out of high-energy metabolic products (glucose, lactate, pyruvate) •• Delay regeneration of the epithelia •• Emulsify the precorneal tear film

5.0 Comparative Information Q. Where does CROMO-FRESH sit with the current treatments available? ®

A. CROMO-FRESH® is the only preservativefree treatment for allergic eyes in a multidose bottle. Other sodium cromoglycate treatments (containing preservatives) are available and there is a preservativefree treatment available in single dose ampoules, but the multi-dose CROMOFRESH® bottle provides on-the-go convenience during the allergy season.

Q. How is CROMO-FRESH® different?

A. The patented technology in the COMOD® multi-dose application system ensures that contaminated ambient air cannot come into contact with the solution, and this perfectly sterile environment allows CROMO-FRESH® to be both preservative and phosphate-free. This system also ensures that at least 300 drops are precisely and consistently delivered from every bottle.

Preservatives may also cause adverse reactions depending on:

•• •• •• ••

Preservative-free ophthalmic drugs are recommended for patients in longterm treatment, with ocular surface diseases, and sensitivity to preservatives.

Preservative-free treatments are particularly recommended for those suffering from allergies, glaucoma and dry eyes.

Q. What are the main patient advantages with CROMO-FRESH®?

A. CROMO-FRESH® provides:

•• Anti-allergic efficacy without •• ••

“For the prevention and treatment of allergic eye conditions such as hayfever, allergic conjunctivitis and vernal keratoconjunctivitis.”

Frequency of administration Duration of treatment Wearing of contact lenses Health status of the cornea

•• ••

sedating or other side-effects (e.g. corticosteroids) Reduction of frequency and severity of allergic symptoms Effective treatment of chronic and acute, annual and seasonal allergic conjunctivitis Excellent tolerance - suitable for adults and children No preservatives in a handy multidose bottle.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 39 : DECEMBER 2014 / JANUARY 2015

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44

WHAT’s NEW & company news

What’s News with Pete Packette Over 200,000 Packettes have been dispensed by community pharmacies in the last month. Pete is packed by MPS Australia whose Community Medication Management System has received Guild endorsement.

As George Tambassis, National President of The Pharmacy Guild commented, “The Guild has endorsed the MPS Community Medication Management System because we believe it provides a better medication management solution for community pharmacy, and that for any pharmacy focused on providing better health outcomes for their patients an efficient, scalable medication management system is absolutely essential.”

“We are all familiar with the statistics. Approximately 50 per cent of patients don’t take their medication as prescribed by their healthcare professional. This medication non-adherence compromises the effectiveness of treatments, increases the risk of medication incidents and reduces quality of life”.

“Saliva is essential to moisten and cleanse the mouth and digest food. Rapids Dry Mouth Strips provide an effective solution for anyone not producing enough saliva.”

New Dry Mouth Strip from CareDent Twenty five per cent of older people and ten per cent of the general population suffer from dry mouth, a problem that occurs from a lack of saliva in the mouth. CareDent has launched Rapids Dry Mouth Strips, a fast acting relief for dry mouth sufferers.

Rapids Dry Mouth Strips dissolve effectively when placed on the tongue and increases the flow of saliva by more than 100 per cent. They are effective for up to two hours and the application can be repeated as often as necessary up to 12 times per day.

“Dry mouth occurs when there is not enough saliva produced,” explained Dr David Young, Dental Surgeon, DJY Dental. “It is caused by a number of factors including the use of medications, dehydration and infection.

Saliva is essential to moisten and cleanse the mouth and digest food. Rapids Dry Mouth Strips provide an effective solution for anyone not producing enough saliva.

Rapids Dry Mouth Strips are available from Coles, IGA, pharmacies and through dental professionals nationwide.

RRP $9.95 For stockist details, please contact Doward International on 1800 369 273.

“In conjunction with the cost of preparing a DAA, and the sheer growth in the number of elderly Australians taking multiple medications and living at home, we know Community Pharmacy needs a solution to be able to cope”.

Watch this space in future as Pete brings you regular tips to get the most out of your DAA business. To learn more call MPS Australia on 1800 003 938.

LBMR – Nicole Livingstone Australian Olympic swimming champion Nicole Livingstone O.A.M has been announced as the official brand ambassador for international award winning medical device, Salin Plus - the world’s only salt therapy device suitable for home use.

Recognising the critical role pharmacists and pharmacy assistants play in recommending appropriate hay fever treatments to their customers, Lion Healthcare - the exclusive Australian and New Zealand distributor for Salin Plus – has also announced WyMedical Pty Ltd as their new pharmacy sales team from 1 October 2014. Lion Healthcare can provide pharmacies with POS material including product brochures, posters, window display hero boxes and DVDs featuring customer testimonials. Uniquely, a demonstration device can also be provided for staff use and for customers to hire. Lion Healthcare also provides in-pharmacy product training through Wymedical on 1800 812 097 and the Salin Plus online training module can be accessed via iTherapeutics. com.au.

Salin Plus works by replicating the “micro climate” found in salt caves, removing air borne pollutants and enriching the air with salt ions. This passive and non-invasive approach ensures better quality air is being inhaled, while helping to remove the airborne allergens from airways and sinuses that trigger hay fever. It’s suitable for adults and children from babies to teenagers, is easy to use thanks to its noninvasive nature, requires minimal maintenance and has quiet operating levels. The Recommended Retail Price (RRP) for Salin Plus is $239.95.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 39 : DECEMBER 2014 / JANUARY 2015

WHAT’s NEW & company news

Nature’s Own launches first to market Red Algal product

New Cenovis Vitamin Gum available now

Nature’s Own has launched an innovative, first to market Omega-3 formulation combining microalgae derived DHA, Aquamin and concentrated fish oil, offering the highest level of Omega-3 DHA1.

Cenovis has launched an exciting range of sugar free Vitamin Gum.

Eight times stronger than Krill2, the patented Red Algal formulation high in DHA, is sourced directly from the same micro-algae that fish, krill and calamari obtain their Omega-3.

Considered one of the most complex yet powerful forms of Omega-3, DHA is an essential fatty acid that may be difficult to get from diet alone if you don’t eat the recommended amount of oily fish and has been shown to play a key role in brain function and cognition.

“Not all Omega-3s are made equal, just because a product contains the essential fatty acid doesn’t necessarily mean it offers therapeutic benefits.

While it is widely understood that Omega-3 is the key to healthy ageing with benefits spanning general health as well as heart, brain memory, eye and joint health, scientific evidence has identified that it is the DHA level that offers the greatest health benefits.

For more information please contact Sanofi Consumer Healthcare 1800 732 273.

Mike Abbott, Head of Marketing for Sanofi Consumer Healthcare, the makers of Cenovis, said the Vitamin Gum range was developed following an extensive program to understand the changing needs of consumers.

“Consumers have been telling us they want innovative products in a variety of formats,” he said.

“At times when life is particularly busy, consumers are looking for new options. We know gum is a popular choice for many Australians, with approximately 60% of adults choosing to chew gum[1].

“Cenovis Vitamin Gum offers those people a great tasting, sugar free, choice in store.”

Vitamin Gum is available in two formulas, across three flavours:

•• Peppermint – Stress & Energy RRP $2.49. Contains vitamins which contribute to the reduction of tiredness and fatigue, normal energy production and normal nervous system function •• Spearmint – Multivitamin RRP $2.49. Contains vitamins which contribute to normal energy production and normal immune system function.

•• Grape – Multivitamin RRP $2.49. Contains vitamins which contribute to normal energy production and normal immune system function.

For more information, speak with your Sanofi Consumer Healthcare Representative or call 1800 732 273.

References: 1 Within the Nature’s Own range 2 Nature’s Own Ultra Krill Oil 1000mg

“Not all Omega-3s are made equal, just because a product contains the essential fatty acid doesn’t necessarily mean it offers therapeutic benefits.”

AUSSIE DOCTORS BECOME VIRTUAL AID WORKERS Inequality within healthcare is becoming increasingly obvious, especially when it comes to the provision of services that are available to first and third world countries.

Bridging the gap of disparity, Twice The Doctor is a not for profit charity who enable Australian healthcare professionals to virtually donate one day of pay to fund the employment of doctors and primary healthcare workers in Africa.

Twice The Doctor have developed a way for doctors to e volunteer without having to leave the practice.

Twice The Doctor Director, Dr Robert Baume says that, “the realities of a busy practice and family life often prevent them from ever actually making the journey.”

A doctor in Africa earns approximately about $12,000 per annum and a nurse approximately $2,000. In Australia, the daily earnings for a doctor could pay an African doctor for an entire month and a nurse for six.

Twice The Doctor has partnered with the Fred Hollows Foundation and UNICEF to ensure the funds are delivered where they are needed most. At the inaugural event, Doctor’s Day in May 2014, $200,000 was raised. The charity plans to extend this initiative nation-wide and will be hosting their second event on May 21st 2015.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 39 : DECEMBER 2014 / JANUARY 2015

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46

WHAT’s NEW & company news

Metamucil and Heart Research Australia join forces In an Australian first, Metamucil and Heart Research Australia have joined forces to create an iPhone and Android app that produces one-of-a-kind music tracks from the rhythm of the user’s heartbeat.

The app is free and available to download now on iTunes/Google Play. The app follows on from the success of the ‘Listen to Your Heart’ campaign which toured Australia earlier this year, where interactive heartbeat pods encouraged Australians to listen to their hearts and maintain low cholesterol levels.

HOW TO GET REFLUX CONVERSATIONS STARTED WITH CUSTOMERS RB (Reckitt Benckiser) has launched a new educational video aimed at pharmacists, offering guidance on how to engage and educate patients suffering from gastro-oesophageal reflux disease (GORD) and breakthrough acid reflux. The video depicts an in-pharmacy scenario of a pharmacist, Belinda Nankivell, engaging with a patient currently taking proton pump inhibitors (PPI) medication and still experiencing discomfort.

The video supports the Time for Gaviscon programme and is available now via RB Health Hub. Pharmacist and pharmacy owner Belinda Nankivell explains, “Gastro-oesophageal reflux and acid reflux are commonly reported in pharmacy therefore pharmacists are used to seeing patients with common symptoms of both.

Those suffering from symptoms may benefit from symptom relief with prescription heartburn medication, yet 1 in 3 people on prescription medication still experience ‘breakthrough’ symptoms. Pharmacists are well placed to assist with this proportion of patients, who are likely to self-medicate, to help them achieve optimum symptom management and reduce discomfort.”

All of the key information on the Time for Gaviscon programme and GORD Matters training module can be accessed on the RB Health Hub. Pharmacists can also sign up can order a Gaviscon Starter kit to help challenge customers to try Gaviscon alongside their PPI.

“Gastro-oesophageal reflux and acid reflux are commonly reported in pharmacy therefore pharmacists are used to seeing patients with common symptoms of both.”

The app uses an iOS / Android device to detect the user’s heart rate, and then generates custom music in any genre they choose.

Pressing a finger against a device’s camera for a minute allows the software to detect tiny changes in the finger’s colour as blood flows, determining heart rate and in turn, reflecting that heart rate in the music generated. The app also tests Australia’s knowledge of cholesterol with a series of true or false questions. The results of the quiz can be shared on Facebook to raise awareness of the importance of maintaining healthy cholesterol levels. To download head to: https://itunes.apple.com/ WebObjects/MZStore.woa/wa/viewSoftware?id=916855524&mt=8

Don’t Let the Sun Steal Your Beauty SunSense SPF 50+ - help protect your skin daily We all know to lock our cars each time we park and we’re conscious of covering our PIN number each time we withdraw money at the ATM, but there’s another thief that creeps around every corner just waiting to steal the fun – the sun’s UV Rays.

The new campaign from the leading suncare brand in pharmacy SunSense1, highlights the damaging effects sun exposure can have on unprotected skin including premature ageing, pigmentation and developing precancerous skin changes – encouraging vigilance on a daily basis.

Vigilant sun protection habits from an early age are essential as the majority of a person’s lifetime sun exposure occurs before the age of 182.

SunSense has always believed in providing the highest UV protection for Australians and has a sunscreen product suitable for each family member and skin type.

An SPF 50+ sunscreen, when used correctly, can reduce harmful UV radiation reaching your skin by approximately 50% when compared to an SPF 30+ sunscreen3.

The SunSense range is available exclusively to pharmacies nationally.

Always read the label and use only as directed. Avoid prolonged sun exposure. Wear protective clothing, hats and eyewear.

References: 1 Aztec Suncare Pharmacy, Value MAT to 04/05/14 2 World Health Organization. Global Solar UV Index - A practical guide [Online].

2002 [cited 2014, Jul 14]. Available from: http://www.who.int/uv/publications/en/ UVIGuide.pdf 3 SPF 30+ is defined as SPF 31 as per AS/NZS 2604:1998 and SPF 50+ is defined as 60.1 as per AS/NZS 2604:2012

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 39 : DECEMBER 2014 / JANUARY 2015

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48

PRODUCT SPOTLIGHT

Preservative-free relief for allergic eyes in a revolutionary bottle

Gold Cross Diarrhoea Relief – Loperamide with Simethicone

CROMO-FRESH eye drops (sodium cromoglycate 2% w/v, 10mL) provide preservative-free relief for itchy, allergic eyes using the unique COMOD® multi-dose application system. It precisely delivers at least 300 sterile drops, protects the solution from contaminated ambient air, and is the only preservative-free treatment for allergic eyes in a handy multi-dose bottle.

Gold Cross is proud to announce the launch of its pharmacy exclusive Gold Cross Diarrhoea Relief tablets – Loperamide with Simethicone. Each tablet contains 2mg of Loperamide HCl and 125mg of Simethicone for the treatment of acute diarrhoea and associated gas-related abdominal discomfort. >> www.trustgoldcross.com.au

>> www.aftpharm.com/au

FIND RELIEF FROM THE SYMPTOMS OF CYSTITIS

Gold Cross Decongestant – Pseudoephedrine HCl 60mg

Ethical Nutrients Urinary Tract Support is a formula containing herbs used in Traditional Chinese Medicine which may:

Gold Cross is proud to announce the launch of pharmacy strength Gold Cross Decongestant with Pseudoephedrine.

Each tablet contains 60mg of Pseudoephedrine HCl for the temporary relief of nasal congestion, easing the pressure that leads to headache and pain and helping you breathe freely.

•• Relieve the symptoms of pain, burning and frequency in cystitis.

•• Relieve symptoms of cystitis.

•• Maintain urinary tract health.

•• Detoxify the urinary system and have antimicrobial like action.

Always read the label. Use only as directed. If symptoms persist consult your healthcare professional. If pain or irritation persists for more than 48 hours consult your doctor.

The presence of blood in the urine warrants immediate medical attention.

For more information call your iNova Representative or Customer Service on 1300 363 212.

Always read the label. Use only as directed.

Your Pharmacists advice is required. If symptoms persist see your healthcare professional. >> www.trustgoldcross.com.au

CHC53039 – 09/13 ETH5989 – 09/13 >> www.ethicalnutrients.com.au GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 39 : DECEMBER 2014 / JANUARY 2015

PRODUCT SPOTLIGHT

Help build strong bones with Cal-500 Cal-500 is a high potency calcium supplement formulated to strengthen bone. Cal-500 aids in reducing the risk of osteoporosis where dietary calcium intake is inadequate. Cal-500 assists in the prevention and treatment of osteoporosis.

Each Cal-500 chewable mint flavoured tablet contains calcium carbonate B.P. 1250mg per tablet equivalent to 500mg elemental calcium.

Cal-500 contains no added sugar, lactose, gluten, salt, artificial preservatives or colourings. Cal-500 is PBS listed and is available in bottles of 60’s (RRP $ 7.95).

Now available direct from Symbion, Sigma & API. Contact your Clear Sales representative on 1800 640 043 for special deals. >> www.petrus.com.au

HARTMANN MoliCare Mobile®

Blackmores Kids Vitamin C + Zinc gummies

MoliCare Mobile provides superior leakage protection and keeps the skin pH balanced, looking after skin where it needs it most.

Blackmores Vitamin C + Zinc Gummies are naturally delicious strawberry flavoured gummies specially formulated with vitamins C, A, D and zinc to support growing kids’ immunity.

•• Slim contoured shape provides an ideal-fit with

•• •• •• •• ••

no slippage or bulge •• Soft and breathable to maintain a healthy skin climate •• Available in multiple sizes and absorbency levels Contact Havenhall for more information

No added sugar Less than 0.5% sugar Natural colours and flavours No artificial sweeteners Great-tasting strawberry flavour

>> www.hartmann.com.au

Always read the label. Use only as directed. Vitamin supplements should not replace a balanced diet

>> 1300 736 003

>> www.blackmores.com.au

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 39 : DECEMBER 2014 / JANUARY 2015

49

Wholesaler

Symbion

Sigma

API

PDE Number

105015

154856

656321

52

After Hours

AFTER HOURS

December 2014/January 2015

Rolex Sydney Hobart Yacht Race Over the past 69 years, the Rolex Sydney Hobart has become an icon of Australia’s summer sport, ranking in public interest with such national events as the Melbourne Cup horse race, the Australian Open tennis and the cricket tests between Australia and England. No regular annual yachting event in the world attracts such huge media coverage than does the start on Sydney Harbour.

The 1000 or so people who crew on board the yachts contesting the Rolex Sydney Hobart come from many countries of the world and from many different professions.

Over the years, the Rolex Sydney Hobart and Cruising Yacht Club of Australia have had marked influence on international ocean yacht racing. The club has influenced the world in race communications and sea safety, maintaining the highest standards for yacht race entry. The club’s members have also fared well in major ocean racing events overseas, with victories in the Admiral’s Cup, Kenwood Cup, One Ton Cup, the Fastnet Race and the BOC Challenge solo race around the word, not to mention the America’s Cup.

Sea, down the south-east coast of mainland Australia, across Bass Strait (which divides the mainland from the island State of Tasmania), then down the east coast of Tasmania.

At Tasman Island the fleet turns right into Storm Bay for the final sail up the Derwent River to the historic port city of Hobart.

landscape and sea scapes found anywhere in the world.

People who sail the race often say the first and last days are the most exciting.

The race start on Sydney Harbour attracts hundreds of spectator craft and hundreds of thousands of people lining the shore as helicopters buzz above the fleet, filming for TV around the world.

Hundreds of people crowd the foreshores of Sullivans Cove to cheer the yachts and their crews while volunteers from the finishing club, the Royal Yacht Club of Tasmania, meet the weary crews with open arms and famous Tasmanian hospitality, and escort them to their berth in the Kings Pier marina.

The 628 nautical mile course is often described as the most grueling long ocean race in the world, a challenge to everyone who takes part.

The final day at sea is exciting with crews fighting to beat their rivals but also looking forward to the traditional Hobart welcome, and having a drink to relax and celebrate their experience.

From the spectacular start in Sydney Harbour, the fleet sails out into the Tasman

Between the first and last days the fleet sails past some of the most beautiful

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 39 : DECEMBER 2014 / JANUARY 2015

The New South Wales coast is a mixture of sparkling beaches, coastal townships and small fishing villages, although for most of the race south the yachts can be anywhere between the coastline and 40 miles offshore.

It’s an event that Tasmanians love to host in the middle of Hobart’s Taste of Tasmania Festival.

Then it’s time to celebrate or commiserate, swap yarns about the race with other crews over a few beers in Hobart’s famous waterfront pubs such as the Customs House Hotel or the Rolex Sydney Hobart Dockside Bar.

Business directory

Business Directory AFT PHARMACEUTICALS Level 1, 296 Burns Bay Road Lane Cove NSW 2066 Tel: 02 9420 0420 Website: www.aftpharm.com

INOVA PHARMACEUTICALS Level 10, 12 Help Street Chatswood NSW 2067 Tel: 02 8918 6322 Website: www.inovapharma.com

Tony Ferguson Tel: 1800 612 644 Website: www.tonyferguson.com

BLACKMORES 20 Jubilee Ave, Warriewood NSW 2102 Tel: 1800 808522 Website: www.blackmores.com.au

CARE PHARMACEUTICALS

LEASE1 Retailer House – Level 1, Unit 3 321 Kelvin Grove Road Kelvin Grove QLD 4059 Tel: 1300 766 369 Website: www.lease1.com.au

Suite 302 Level 3 75 Grafton Street NSW 2022 Tel: 02 9300 1900 Website: www.carepharma.com.au

MPS Ezy-Ups

8 Clunies Ross Court Eight Mile Plains QLD 4115 Website: www.mps-aust.com.au

Level 1 / 25 York St Launceston TAS 7250 Website: www.ezyups.com

Would you like to advertise in our new Business Directory?

OpticaLife FLOWSELL 1/13 Network Dr, Carrum Downs VIC 3201 Tel: (61-3) 9708 2276 Website: www.flowsell.com.au

PO Box 9410 Tower Junction Christchurch 8149 New Zealand Website: www.opticaaccessories.com.au

HEALTH WORLD

PETRUS PHARMACEUTICALS

741 Nudgee Road Northgate QLD 4013 Tel: 07 3117 3300 Website: www.healthworld.com.au

P.O. Box 1808 West Perth WA 6872 Tel: 08 9368 5954 Website: www.petrus.com.au

Contact Jess O’Connor on Ph: 07 3040 4415 or Email: jessica.oconnor@goldx.com.au

53

60 SECONDS WITH...

Jane larter Professional Practices Pharmacist I decided to become a pharmacist because... I wanted to do something worthwhile that helps people. The industry has so many avenues to explore and many different ways of achieving this.

I have been working as a pharmacist for...

6 years but have worked in pharmacy for 16 years.

What I like best about my job is... training both interns and pharmacy assistants. Knowing I can impart only that tiny bit of knowledge that may help them become better in their profession makes me feel like Iâ&#x20AC;&#x2122;ve helped them.

My favourite hobby is... reading. There is nothing I enjoy more than sinking into a nice comfy couch with a good book and a nice cup of tea (or glass of wine).

My favourite book is...

The Count of Monte Cristo.

My best getaway ever was... my trip to the USA last year with my partner.

He and I travelled to 5 different cities in 3 weeks (including 7 days in New York City). A whirlwind trip but a very memorable experience.

How I keep myself updated to the market news... is by reading pharmacy journals and online media.

Over the next 3 years in pharmacy, I predict... professional services to be the only viable option for pharmacy and forward pharmacy to be much more common in the community pharmacy environment.

If I could give any advice to someone starting a career in pharmacy, it would be... donâ&#x20AC;&#x2122;t limit yourself. Pharmacy has many different avenues and it allows you the ability to find your niche in a great health profession.

30 0

54

s - 10ml op dr

can be used months after opening preservative-free phosphate-free compatible with all contact lenses

CLASSIFIEDS FOR SALE DD safe (DS2 size) for sale $500. External dimensions 600 (h) x 450 (w) x 150 (d). It has two shelves - the top one has a cutout to fit a methadone bottle with measure attached. Four holes in the back for wall mount, or three in the floor for floor mount. Key locking mechanism. Two keys included. Brisbane northside.

4 x Clexane 100mg x 10 Exp 10/2016 $72.00 each 1 x Topamax 100mg Exp 01/2016 $34.50 each Contact: Penguin Pharmacy, Vicky or Chelsea Ph: 03 64 372262 or email penguinpharmacy@yahoo.com.au

Contact: Albany Hills Pharmacy, Penelope James Ph: 0418 736 300 1x Arcoxia 120MG 10 Tabs exp May-15 $13.40 20% off the wholesale price off the following:

3x Caverject Impulse 10MCG INJ exp Feb-15 $10.00

9 x Sandoz mycophenolate 500mg tab 50 (exp 03/15)

3x Caverject Impulse 20MCG INJ exp Mar-16 $18.00

6 x Prograf XL 5mg cap 30 ( 1 x exp 10/15; 1 x exp 08/15; 2x exp 02/19; 2x exp 06/16)

1x Galantyl 8MG 28 Caps exp Apr-15 $26.00

1 x Prograf XL 1mg cap 60 (exp 08/16)

4x Dilantin Infatabs 50MG 200 Tabs exp Dec-14 $16.00

2 x Prograf 0.5mg cap 100 (exp 10/16)

2x Hytrin 2MG 28 Tabs exp Jan-16 $18.01

1 x Certican 0.25mg tab 60 (exp 05/16)

3x Novoban 5MG 2 Caps exp May-15 $30.00

3 x Certican 1mg tab 60 ( exp 09/16)

1x Oxis 12MCG Turbuhaler 60 Dose exp Feb-15 $18.00

2 x Dipentum 500mg tab 100 (exp 05/16)

2x Strattera 10MG 28 Caps exp Mar-16 $76.00

1 x Neotigason 10mg cap 100 (exp 06/15)

1x Captopril Sandoz 50MG 90 Tabs exp Mar-16 $8.00

1 x Abilify 20mg tab 30 (exp 01/16)

1x Accupril 5MG 30 Tab exp Apr-15 $3.00

6 x Aranesp 60mcg/0.3mLx4 (exp 06/15; 02/16)

1x Genrix Gabapentin 600MG 100 Tabs exp May-15 $33.00

Contact: Croydon Park Pharmacy, Rowena 02 4625 1460 or Jenny 02 9798 8417

1x Sensipar 30MG 28 Tabs exp Nov-16 $160.00

3 x Tetrabenazine 25mg 112 tablets to be sold for $200 each. Exp 01/2018

1x APO-Galantamine MR 16MG 28 Caps exp Sep-15 $26.00

Contact: Superchem Discount Pharmacy, Melisa Anzulovic, Ph: 08 9271 8400 or melisa@bonmore.com.au 316 Walcott Street, Menora WA 6050

1 x Prograf 1mg (100 CAPS) to be sold for $300. Exp 08/2016 1 X Cellcept 500mg (50 tabs) to be sold for $70. Exp 06/2015

2x Strattera 60mg 28 capsules exp 01/2015 $60

1x Baraclude 0.5mg (30 tabs) to be sold for $300. Exp 12/2015

1x Zytiga 250mg 120 tablets exp 09/2015 $2,500

1 x Sporanox 100mg (60 caps) to be sold for $150. Exp 03/2016

1x Renagel 800mg 180 tablets exp 12/2015 $200

1 x Imojev vaccination to be sold for $200. Exp 27/11/2016

1x Comtan 200mg 100 tablets exp 04/2015 $80

Contact: Day and Night Chemist, Newtown, Ibrahim Edelbi Ph: 02 9557 1376

1x Propecia 1mg 28 tablets exp 05/2015 $60 Contact: Veronica, Chapman Pharmacy, Ph: 02 62888684 Fax: 02 62880410 Perry Drive Shopping Centre Chapman ACT 2611

1x brand new Deblister Machine in box RRP $6,050, sell price $2,500 Contact: Gladis Hanna, Yagoona Station Pharmacy, Ph: 02 97961979 or 0411 292 919 516 Hume Highway Yagoona NSW 2199

1x Levetiracetam 1000mg exp Jan 2015 30% discount $57.00 1x Zovirax opthalmic oint exp Feb 2015 20% discount $21.60 1x Accu-Chek Mobile exp Feb 2015 20% discount $32.90

2 X Black toners for Kyocera FS-C5200DN PRINTER $500.00 package

2x Modavigil 100mg exp Dec 2015 15% discount $133.45

1 X Magenta toners for Kyocera FS-C5200DN PRINTER $500.00 package

1x Barbloc 5mg exp Mar 2015 20% discount $16.70

Seperately - Black $150 each, RRP is $184

1x Pulmicort Turbuhaler 200mcg exp Mar 2015 20% discount $16.70

Seperately - Magenta $220, RRP is $249

PRINTER TONER KITS FOR KYOCERA FS-C5200DN- BRAND NEW

Contact: Goldfields Fullife Pharmacy Gympie, Eleisha Kirk, happy to post Ph: 07 5482 9671

2x TK554K Black $65 2x TK554M Magenta $79 1x TK554Y Yellow $79

COST LESS 20%

2x TK554C Cyan $79

1x Strattera Cap 100mg 28 exp 07/2015

Contact: Vienna Road Family Chemist, Alexandra Hills Ph: 07 3824 8282

COST LESS 50% 1 x Actos 30mg tab 28 exp 01/2015 1x Cyprostat 100mg tab 50 exp 01/2015 1x Estraderm MX 50 Patch exp 03/2015

PLACE YOUR FREE CLASSIFIED ADVERT

1x Galvumet 50mg/500mg exp 12/2014

If you would like to place your free classified ad, forward any items for sale to Jess O’Connor. Email: jessica.o’connor@goldx.com.au

1x Intal 1mg MDI exp 01/2015 1x Minidiab 15mg tab exp 01/2015 1x Nardil 15mg tab exp 12/2014

BROUGHT TO YOU BY:

1x Saphris Wafer 10mg 60 exp 02/2015 1x Stalevo Tab 125mg/31.25mg/200mg exp 12/2014 1x Stieva A Forte Cream 0.1% 25g exp 12/2014 Contact: Palmyra Chemmart Pharmacy, Susanna Ph: 08 9339 5522, 267 Canning Hwy Palmyra, WA 6157

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 39 : DECEMBER 2014 / JANUARY 2015

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HEALTH CALENDAR

HEALTH CALENDAR December 2014 / January 2015 World AIDS Day 1st December World AIDS Day – held on 1 December each year. It raises awareness across the world and in the community about the issues surrounding HIV/AIDS. It is a day for people to show their support for people living with HIV and to commemorate people who have died.

Carols by Candlelight 1st December Vision Australia’s Carols by Candlelight presented by Myer has been the iconic centerpiece of Australian Christmas tradition for 76 years. In 2014 we are once again looking forward to sharing this experience with you and bringing Australia a fantastic show and evening of Christmas entertainment.

Sussan Women’s Fun Run 7th December Join us on Sunday 7 December 2014 as thousands of Victorian and Interstate women of all ages and fitness levels, come together at St Kilda’s Catani Gardens in Support of Breast Cancer Network Australia.

International Day of People with Disability 3rd December International Day of People with Disability (IDPwD) is a United Nations sanctioned day that aims to promote an understanding of people with disability and encourage support for their dignity, rights and well-being.

Human Rights Day 10th December The UN General Assembly proclaimed 10 December as Human Rights Day in 1950, to bring to the attention ‘of the peoples of the world’ the Universal Declaration of Human Rights as the common standard of achievement for all peoples and all nations.

International Volunteer Day 5th December International Volunteer Day (IVD) is celebrated each year on 5 December and was established by the United Nations General Assembly in 1985. IVD provides volunteer organisations and individual volunteers with the opportunity to raise the public awareness of their contributions to economic and social development at local, national and international levels.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 39 : DECEMBER 2014 / JANUARY 2015

Australia Day 26th January On Australia Day, over half of the nation’s population of 21 million attend either an organised community event, or get together with family and friends with the intention of celebrating our national day. Many more spend the public holiday relaxing with family and friends.

Our TV ADVERTISING draws customers to your store. draw

Our TRAINING

enables you to give them the best advice.

Our COMMITMENT

to you ensures they come back to you!

MAY HELP REDUCE THE SYMPTOMS OF MEDICALLY DIAGNOSED IBS: • • • • •

Intestinal pain Constipation Diarrhoea Bloating Gas

1 IN 5 AUSTRALIANS SUFFER FROM IBS

1

Ethical Nutrients IBS Support contains an exclusive and clinically proven probiotic strain, Lactobacillus plantarum (299v), which has been the subject of over 80 clinical studies and 7 human trials.

A clinical trial showed 95% of IBS sufferers had improvements in all symptoms2.

Our successful and ongoing TV campaign supports this product and drives IBS sufferers into your store (not a nearby supermarket), where they can receive informed advice about how to break free from the symptoms of medically diagnosed irritable bowel syndrome.

www.ethicalnutrients.com.au BEST PRODUCTS BEST EDUCATION Industry Pulse independent research shows Ethical Nutrients, yet again, BEST SERVICE as the leading supplier to Pharmacy providing unparalleled service excellence and product training for the 5th consecutive year!

Ethical Nutrients offers professional Natural Medicine training for all staff in your store in a variety of formats to suit the varied needs of your staff: • Online Learning Modules • In-Store Trainings • Training Evenings • itherapeutics.com.au 1

www.ibis-australia.org/index.htm.

2

Always read the label. Use only as directed. If symptoms persist consult your healthcare professional.

Niedzielin K et al, Eur J Gastroenterol & Hepatol 2001, 13:1143-1147. Department of Gastroenterology, M. Curie Regional Hospital, Poland

ETH6885 - 10/14

YOUR NATURAL BUSINESS PARTNER