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The Falsified Medicines Directive (FMD) is to be implemented in all member states of the European Union (including the UK) and the European Free Trade Area on 9th February 2019. This is a response to the growing number of falsified medicines entering the pharmaceutical supply chain, which can have serious consequences for patient health and safety. But how will it work? (1)

What is FMD?

FMD stands for Falsified Medicines Directive, a term used both to describe the process by which pharmacies will identify the medicines they receive from wholesalers as legitimate or falsified, and to refer to the European Directive on Falsified Medicinal Products, the piece of legislation concerning this process. (2)

What are falsified medicines?

Falsified medicines are illegitimate copies of legitimate medicines, from unlicensed manufacturers. Despite tight controls, some find their way into the supply chain, allowing them to reach patients. They have not been produced in the same highly regulated way in which legitimate medicines are produced by licensed pharmaceutical companies, but are often passed off as coming from such companies due to identical or stolen packaging. Falsified medicines can contain too much or too little of the active ingredient(s), no active ingredients at all, different active ingredients to what is stated on the packaging, and potentially harmful, banned or dangerously concentrated excipients (excipients are all ingredients of a medicine other than active ingredients). Clearly, there is a risk posed to patients, with overdose, drug interactions, poisoning or a condition being left untreated all possible outcomes of taking falsified medicines. (1)

How can you tell if you are buying falsified medicines?

Legitimate online pharmacies such as Webmed are approved and accredited by official regulatory bodies including the  MHRA, GPhC and CQC. The independence and unbiased nature of these bodies provide regulation, monitoring and inspection to ensure we and our peers are held to the highest standards.

You can rest assured that when you purchase treatments from Webmed (from erectile dysfunction medication all the way to Hair Loss Treatments) you are purchasing legitimate, official medicines.

How will FMD be implemented in pharmacies?

From 9th February 2019, two new features will be present on all prescription medicines supplied to pharmacies (bar a handful of specialist medications):

• A unique identifier (UI) – a 2D data matrix, or barcode, unique to each pack of medication

• An anti-tampering device (ATD) – an addition to the packaging that will make it evident whether or not it has been tampered with, such as adhesive seals, shrink wrap, or perforated sections of boxes that must be broken to open the pack. (2)

It is expected that electronic patient medication record (PMR) systems in pharmacies will be updated to incorporate a medicines verification feature that can be used to scan the UIs on packs and identify the medicine as genuine or falsified. By law, stock will not need to be verified until it is being prepared for a patient, but optional verification will most likely be performed when stock is received into the pharmacy, allowing suppliers to be alerted as soon as possible when a suspected falsified medicine is found. (2)

The safest way to verify medicines before supply to patients will be using aggregated codes, if PMR systems allow. During the dispensing process, each pack of medicine will be scanned and codes for all packs to be bagged up for the patient will be ‘aggregated’ and printed on a label to attach to the outside of the bag. Then, when the patient comes in to collect the bagged prescription items (or before handover to delivery drivers), the aggregated codes will be scanned and, if verified as legitimate, all packs inside the bag will be decommissioned, meaning that their UI codes become inactive. Since UIs will be unique by name and nature, the same UI showing up on a further pack will be flagged, highlighting the pack as potentially falsified and unsuitable for supply to the patient. Aggregated codes will be preferable to scanning each item individually as it will mean that the bag does not need to be reopened on handing over to the patient or delivery driver, which will uphold patient confidentiality, save time and lower the risk of a dispensing error. (2)

Once packs are decommissioned, they can be recommissioned (the UI reactivated and the pack put back to stock as long as it hasn’t left the pharmacy) within 10 days. This may happen if a patient no longer requires the item(s) or if a pack is decommissioned in error. (2)

Scanning will also flag up any recalled, discontinued or out of date medicines, further minimising the impact of human error on patient safety. It is hoped that eventually it will even be used to ensure the correct medicine has been picked against the prescription! (2)

Will Brexit have an impact on FMD?

Since FMD is part of EU law, there has been confusion over whether FMD in the UK will be continued after the UK leaves the EU on 29th March 2019. The Department of Health and Social Care (DHSC) and the Medicines and Healthcare products Regulatory Agency (MHRA) have assured “high regulatory alignment” with the EU, meaning FMD will be here to stay. It is also believed that the UK will still be considered part of the EU for the purposes of FMD after Brexit, so the process should remain unchanged – this is the best outcome for ease of operation in pharmacies and for patient safety. (2)

References

1. UKFMD Working Group for Community Pharmacy. FMD (1): What is the Falsified Medicines Directive? [cited 31 October 2018].

2. UKFMD Working Group for Community Pharmacy. The way forward for FMD in community pharmacy [cited 31 October 2018]. Available at: https://www.communitypharmacyni.co.uk/wp-content/uploads/2018/02/fmd-cp-working-group-way-forward-paper-jan-18-public-v1-0-final.pdf

Author: Gabby Gallagher MPharm

Male pattern baldness, sometimes called genetic hair loss or alopecia and rogenetica, affects or will affect as many as two thirds of all men at some point in their lifetime. For many, it is a source of embarrassment and upset and may even contribute to depression in some cases, as hair is often considered to be an important part of our identity, one of many ways in which we can express ourselves. (1)

What is male pattern baldness?

Explore Hair Loss treatments available from Webmed FInd out more Male pattern baldness is the most commonly occurring type of hair loss in men. The first sign is often a bald spot forming on top of the scalp, with thinning of the hair at the temples (sides of the head). Usually a receding hairline will develop. It can sometimes result in complete baldness of the scalp, though this happens rarely, and if it does happen, it’s very gradually. The condition may occur in men of any age, but symptoms most commonly begin to appear in men in their thirties. (1)

Why does male pattern baldness happen?

Male pattern baldness is a genetic condition, meaning it runs in families. It’s commonly believed that the gene responsible is passed from mother to son, but it has been found that genes from either or both parents can contribute to male pattern baldness. (2)

It is believed that the genes involved code for hair follicles (the ‘roots’ from which individual hairs grow on the scalp) that are more sensitive to a hormone called dihydrotestosterone, which causes follicles to shrink and eventually stop working altogether. This translates to hairs becoming thinner and shorter until they are no longer produced. (2)

Can male pattern baldness be cured?

Unfortunately, there’s no cure for male pattern baldness. Thankfully, the progression of the condition can be slowed or stopped with the right treatment. A surgery known as a hair transplant can also be performed for more instant results, but this will still need aftercare with the right treatment. (1)

What treatment is available from Webmed Pharmacy for male pattern baldness?

Buy Finasteride from Webmed from only £20 FInd out more Finasteride is an oral drug used to treat male pattern baldness. It works by lowering dihydrotestosterone levels, helping to slow the shrinkage of hair follicles, therefore promoting hair growth. It may take as long as six months for effects to show. If used after a hair transplant, it can help to maintain the hair. Finasteride needs to be taken daily long-term, otherwise the effects will be lost. It is available to purchase from Webmed Pharmacy as the branded product, Propecia, or the generic, Finasteride. Both the branded and generic products work in exactly the same way as they both have finasteride as the active ingredient at the same strength. The only difference is that the generic is considerably cheaper.

There is now a range of topical products available to purchase from Webmed Pharmacy which can be used alongside finasteride to optimise the effects. These products are recommended by Dr Mabroor Bhatty, one of the top surgeons in the field of hair transplant and cosmetics in the UK.

Visit our Hair Loss Clinic For Total Scalp Care The first of these products is Tony Maleedy Juniper Scalp Therapy Shampoo. Composed of essential oils and moisture-binding compounds of natural origin, it works by deeply cleansing the scalp to remove scale (dead skin and oils); reducing the levels of a fungus which can live on the scalp and cause a number of irritating and uncomfortable conditions such as dandruff, spots and flaking of the scalp; and slowing down the life cycle of skin cells on the scalp, which reduces further build-up of scale. All of this promotes optimum health of the scalp and can strengthen hair follicles, reducing hair loss.

This shampoo should be used at least twice weekly to tackle hair loss, but ideally daily for six months, after which frequency can be reduced.

The next product is Tony Maleedy Juniper Scalp Therapy Conditioner, which can be used alone or alongside the shampoo. Containing four plant-derived organic oils and amino acids, it works by sealing moisture into the hair, preventing breakage and strengthening the hair. This in turn helps to protect against hair loss.

According to Dr Bhatty, Tony Maleedy products can be used both before a hair transplant to prepare the scalp, and afterwards to calm the scalp and promote the health of the scalp and hair.

The final products are Regaine for Men Extra Strength Foam and Solution. The active ingredient in Regaine is minoxidil 5%, and it works by improving blood flow to the scalp, which reinvigorates hair follicles, even reversing the shrinkage in some cases. This will result in thicker, longer, stronger hair growing from the follicles.

Regaine should be massaged into the scalp twice daily, preferably every twelve hours. The hair and scalp must be completely dry before application. It usually takes two to four months to take effect.

All of these products can be used alongside one another to combat hair loss and are available to buy from Webmed Pharmacy as part of an online Hair Loss Clinic, with discounts applied when multiple products are purchased at the same time, or when longer ‘courses’ of treatment are purchased.

Why not visit Webmed’s Hair Loss Clinic  - click here.

If you would like to see what other treatments Webmed can provide, please click here.

Author: Gabby Gallagher MPharm

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 03/10/18. Updated 20/12/19.

References

1. Men’s Health Forum. Hair loss FAQs [cited 20 September 2018]. Available at: https://www.menshealthforum.org.uk/hair-loss-faqs

2. Alopecia UK. Types of Alopecia [cited 20 September 2018]. Available at: https://www.alopecia.org.uk/Pages/FAQs/Category/types-of-alopecia

Cycling is great for both mind and body – depending on whether you’re going uphill, downhill or on a flat surface, or on smooth or rough terrain, you can exercise different muscle groups at different intensities – all while soaking up the sights and sounds of the world around you. But could your daily commute, or your weekend unwind, be damaging your sexual health? A number of studies and news articles over the years have suggested that there may be a link between cycling and erectile dysfunction (ED).

Does research show a correlation between Cycling and ED?

A study conducted in Norway in 1997 collected data from 160 men who had taken part in a long distance bicycle race. It found that 13% of this sample had developed temporary ED after the race, in some cases lasting longer than a month. (1) In 2001, another study on 40 men found that ED occurred in nearly a fifth of long distance cyclists. (2) In 2004, a review of 62 medical articles summarised that up to a quarter of male cyclists had reported ED. (3) And in 2010, a further review found a ‘significant relationship’ between cycling and ED. (4)

The sample sizes (number of people studied) for many of these studies are small – generally the larger the sample size, the more reliable the results of a study are. But clearly the general message from these studies is worth noting, as the NHS Choices page on ED advises men against cycling for three hours or longer per week. (5)

How can I  avoid ED?

The Men’s Health and Cycling UK websites suggest investing in modified bicycle seats. A split bicycle seat has part of the saddle ‘cut out’ to ease pressure on the groin area, especially the pudendal nerve, which runs through the perineum (the area separating the genitals from the anus), which if damaged can lead to ED. Noseless saddles reduce contact between the saddle and the perineum. And saddles incorporating holes and grooves are also available, which are designed to be a better fit to the genital area, reducing pressure. (6, 7)

An article from the prestigious US-based Harvard Medical School also highlights the importance of saddle shape for those concerned about cycling and ED. Wider, softer saddles are preferable to hard, narrow saddles as the weight of the cyclist is spread out over a larger area and the softer seat will put less pressure on the genitals. (8)

Would it be safer if I just stopped cycling altogether?

Absolutely not! Don’t forget, cycling is a superb form of exercise. The better your health and fitness, generally the better your sexual health will be. Just take heed of the above advice and consider supplementing cycling with other forms of exercise if you feel 3 hours a week isn’t enough Even if you do find yourself with ED issues further down the road, there are many treatments available online that can help.

References

1. Andersen KV, Bovim G. Impotence and nerve entrapment in long distance amateur cyclists. Acta neurologica Scandinavica. 1997 Apr;95(4):233-40. Available at: https://www.ncbi.nlm.nih.gov/pubmed/9150814 [accessed 30 August 2018].
2. Sommer F et al. Impotence and genital numbness in cyclists. International journal of sports medicine. 2001 Aug;22(6):410-3. Available at: https://www.ncbi.nlm.nih.gov/pubmed/11531032 [accessed 30 August 2018].
3. Leibovitch I, Mor Y. The vicious cycling: bicycling related urogenital disorders. European urology. 2005 Mar;47(3):277-86; discussion 286-7. Available at: https://www.ncbi.nlm.nih.gov/pubmed/15716187 [accessed 30 August 2018].
4. Sommer F, Goldstein I, Korda JB. Bicycle riding and erectile dysfunction: a review. The journal of sexual medicine. 2010 Jul;7(7):2346-58. doi: 10.1111/j.1743-6109.2009.01664.x. Available at: https://www.ncbi.nlm.nih.gov/pubmed/20102446 [accessed 30 August 2018].
5. NHS Choices. Erectile dysfunction [cited 30 August 2018]. Available at: https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/
6. Men’s Health. Is Your Bike Killing Your Boner? [cited 30 August 2018]. Available at: https://www.menshealth.com/health/a19539158/can-bicycles-cause-erectile-dysfunction/
7. Cycling UK. Boy stuff: cycling, the prostate and erectile dysfunction [cited 30 August 2018]. Available at: https://www.cyclinguk.org/blog/olivercw/boy-stuff-cycling-prostate-and-erectile-dysfunction
8. Harvard Medical School. Can cycling cause erectile dysfunction? [cited 30 August 2018]. Available at: https://www.health.harvard.edu/staying-healthy/can-cycling-cause-erectile-dysfunction

Author: Gabby Gallagher MPharm

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 11/09/18

There are a number of things to consider when deciding on a treatment for erectile dysfunction (ED) - how long will the effect last, how often do I need to take it, how much does it cost? But did you know that tadalafil, once only available as the Cialis brand, is now available to buy online as a generic (unbranded) version?

What is Generic Cialis (Tadalafil)?

Generic forms of any medication are medically identical to the branded originals and are quality controlled to the same standards as the brand name versions; they are just as safe and effective but generally cost much less.

Generic tadalafil contains exactly the same active ingredient as Cialis, but at a fraction of the price. This may be of benefit if you’ve thought about trying Cialis in the past but were put off by the cost. However, cost isn’t the only factor to take into account, and the information below aims to help you decide on the best erectile dysfunction (ED) treatment for you.

Which erectile dysfunction (ED) treatment should I choose: Sildenafil or Tadalafil?

Sildenafil and tadalafil are the two most popular treatments for erectile dysfunction (ED), with sildenafil, brand name Viagra, being the oldest and most well known of the two. But which is better?

Sildenafil is taken an hour before sexual activity, and it will help you get an erection up to at least four hours after taking it, sometimes up to six hours (this doesn’t mean you’ll have an erection that lasts for this length of time - just that you’ll have the potential to have an erection if sexually aroused within the four to six hours after taking). Tadalafil, on the other hand, can be taken 30 minutes before sexual activity and will help you to get an erection up to 36 hours later, so it allows for more sexual spontaneity and has been dubbed “The weekend pill”. Both sildenafil and tadalafil should not be taken more frequently than once a day.

The effect of sildenafil can be impaired if taken with or after food, but tadalafil works just as well taken after a meal as it does on an empty stomach.

Which erectile dysfunction (ED) treatment is best for lactose intolerant people?

If you are lactose intolerant, sildenafil may be the best option as it is available as a lactose free formulation. You can buy the Mylan brand of sildenafil at Webmed, which is lactose free.

Tadalafil can also be taken as a daily dose if you are sexually active at least twice a week. This means you don’t need to worry at all about waiting for the effects to kick in - you’ll be ready for sexual activity at any time.

Other erectile dysfunction (ED) medicines are available besides sildenafil and tadalafil - avanafil, available only as the brand Spedra, is the fastest acting, taking effect in just 15 minutes. Vardenafil, marketed as Levitra, may work more quickly and last slightly longer than sildenafil and tadalafil and may be the most suitable ED medication for people with diabetes.

What’s the best erectile dysfunction (ED) treatment?

Overall, it appears that tadalafil comes out on top when compared with sildenafil, with the notably longer duration of action, slightly faster onset of effectiveness, compatibility with food and the option to take it as a once daily dose. But everyone has different needs, and what works for one person may not work for the next. Hopefully, this information will have helped you to decide on which erectile dysfunction (ED) treatment will be best for you.

To see the full list of erectile disfunction (ED) medication available from Webmed, click here.

Author: Gabby Gallagher MPharm

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 24/08/18

Despite there being a dramatic increase in bowel cancer cases above the age of 50, the screening programme in England is currently only offered to those aged 60 and over. However, Public Health England have recently announced that it plans to bring the starting age for screening down to 50, a move which will mean countless more cases are spotted in the earlier, more easily treatable stages. (1)

What is bowel cancer?

Bowel cancer is cancer of the large intestine, and depending on the area affected, may be referred to as colon cancer or rectal cancer. It is the fourth most commonly diagnosed cancer in the UK, responsible for 42,000 cases and over 16,000 deaths each year. (1, 2)

What are the symptoms?

One of the most common symptoms is blood in your poo. This may be noticed as red streaks on the surface of your poo or the poo being discoloured (red, very dark red/brown or black), toilet water being stained red or pink, or blood visible on toilet paper. Often, blood in poo has other, less serious causes, such as haemorrhoids or anal fissures (cuts). But if you’ve had any of the above symptoms for three weeks or longer, visit your GP. (2, 3)

A change in bowel habit can also be a sign of bowel cancer. One off changes in bowel habit can be caused by eating certain foods or stressful situations, but if this occurs persistently don’t ignore it. If you find you are needing to poo more frequently than what’s usual for you, and the poo is softer and thinner than usual for three weeks or more, see your GP. (2,3)

Another common symptom is lower abdominal pain, discomfort or bloating. This tends to worsen after eating and may therefore put you off eating, leading to weight loss. See your GP if you experience any of the above symptoms. (2, 3)

Other symptoms may include tiredness from anaemia caused by persistent blood loss from the bowel, slime in your poo and feeling like you can’t fully empty your bowel when you poo. (2, 3)

Bowel cancer screening

Currently, the bowel cancer screening programme in England involves inviting everyone aged between 60 and 74 to have a faecal occult blood (FOB) test every two years. This is a simple home testing kit which allows a small stool sample to be collected. When sent to the laboratory, this sample is tested for traces of blood, which could indicate bowel cancer. (1, 2)

A new, more accurate bowel screening kit is due to replace the FOB test this autumn, known as the faecal immunochemical test (FIT). It is the FIT that will be in use when bowel screening is introduced to people aged 50 and over in England. (1)

In some parts of England, a different test is also offered to 55 year olds, called bowel scope screening. During this screening, a healthcare professional will inspect the lower bowel for polyps (small growths that can be an early sign of cancer) using a gentle instrument. (2)

What causes bowel cancer?

Bowel cancer, like all cancers, doesn’t have a definite cause, but there are several risk factors:

• Regularly eating red or processed meat
• Not eating enough fibre
• Being overweight or obese
• Sedentary lifestyle
• Excessive alcohol consumption
• Smoking
• Being 60 years of age or older
• Having a parent or sibling who had bowel cancer under 50 years of age
• Having had ulcerative colitis or Crohn’s disease for over 10 years

As you can see, some factors are unavoidable, but others can be changed. A diet high in fibre, fruit and vegetables and low in red and processed meat will help protect against bowel cancer, as will stopping smoking (if applicable), drinking alcohol in moderation or not at all, getting moderate exercise regularly and maintaining or attaining a healthy weight. (2)

For more information and support, visit Bowel Cancer UK here.

References

1. BBC News (2018). Bowel cancer screening to start earlier at age 50 in England [cited 13 August 2018]. Available at: https://www.bbc.co.uk/news/health-45143895

2. NHS Choices. Overview: Bowel cancer [cited 13 August 2018]. Available at: https://www.nhs.uk/conditions/bowel-cancer/

3. NHS Choices. Bleeding from the bottom (rectal bleeding) [cited 13 August 2018]. Available at: https://www.nhs.uk/conditions/bleeding-from-the-bottom-rectal-bleeding/

   Author: Gabby Gallagher MPharm

   Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 15/08/18

Meet Poorly Boo

How did it all start?

Poorly Boo was the vision of Mumpreneur Manju Bhatia, who quickly realised that many new parents did not have the essential remedies in their homes for when their little ones became ill. Having young children herself, Manju was often in the company of other mums with small children and often heard them saying their baby had a high temperature and had to run out to get some medicine.

Manju thought, “Why are so many new parents so ill equipped at home? Why do so many not have the medicine in the cupboard to alleviate their symptoms?”

When Manju become a mum in 2013, she made sure she was prepared with all of the remedies and over-the-counter medications that she might need. Although it didn’t stop the sleepless nights when they were poorly, it did mean she had what she needed so the family could all rest a bit easier.

Since 2017, Poorly Boo has been selling essential healthcare products online at: https://poorlyboo.com/

Who is Manju?

Manju Bahtia is originally from Yorkshire, where her interest in business came from working in her parents’ uniform shop, Natasha’s.  The family run business, which had several outlets in Yorkshire, sold school uniforms to dozens of schools in the region. At a young age, Manju had a strong business nous and enjoyed the buzz of a business environment.

Manju helped her father set business goals and was successful in growing the business to reach a turnover of more than £1 million.

After successfully reaching their goal of £1million, Manju left her family home to get married and start her own family. She focused her attention on raising her 2 children, and after spending time with new mums and their babies, Manju realised there wasn’t anything in the market to help new parents understand what medicines and remedies were important to have on hand.

Her eureka moment came during these conversations, and PoorlyBoo was soon launched.

Discover Poorly Boo's Products

PoorlyBoo Baby Box

13 carefully selected must have products, all parents will need to deal with the most common baby illnesses and give peace of mind to all worried parents. Put together in a travel sized medicine box, that can be stored at home or taken away with you.
RRP £34.99

What's in the box?

• Vapour rub
• Teething gel
• Teething granules
• Digital thermometer
• Sudocrem - antiseptic healing cream
• Metanium nappy ointment
• Medicine dispenser
• Olbas for children – inhalant decongestant oil
• Paracetamol 120mg/5ml oral suspension
• Ibuprofen 100mg/5ml oral suspension
• Saline solution nasal drops
• Nasal aspirator
• Infacol oral suspension

Poorly Boo First Aid Kit

100 piece First Aid Kit, for Travel, Car, Home, or Work.  A complete kit to protect you and your family.
RRP £14.99

What does the first aid kit include?

• Ice pack
• Thermal blanket
• Tweezers
• Scissors
• Bandages
• Plasters
• and much more

Find out more

You can find Poorly Boo at https://poorlyboo.com or join the conversation on Twitter, Facebook and Instagram

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 03/08/18

Group B Strep - should I get tested?

Group B Strep is the most common cause of life-threatening infection in newborn babies in the UK, and the most common cause of meningitis in babies under age 3 months and yet a lot of pregnant mums know nothing about it!

At least two babies every day in the UK fall ill with Group B Streptococcus (often known as Group B Strep or just GBS). For some, the illness is fatal, for others, it can cause permanent disabilities.

The following information may help you to gain a better understanding of GBS and to make an informed decision on whether a GBS test may be right for you! (1)

What is GBS?

GBS is a type of bacteria which forms part of the natural bodily flora of up to four in ten people. Up to a quarter of women also carry the bacteria in the vagina. Usually, the bacteria are harmless, but in certain cases such as in people with a compromised immune system, babies and pregnant women, it may develop into an infection. (1)

If a woman carries GBS in her vagina and becomes pregnant, there’s a small chance that she could pass the bacteria on to the baby during childbirth. Because the immune system of babies is not yet developed, it is much easier for GBS to get out of control and make them ill. For a small number of babies it can be life-threatening, causing blood poisoning, pneumonia and meningitis. This may lead to death in a very small number of cases. (2)

Will the NHS test for Group B strep?

Despite this, there is no routine testing provided on the NHS. Even if a pregnant woman is offered testing it’s usually the Standard ‘non-selective’ test for group B Strep carriage. A negative result using this method is not very reliable – it gives a high proportion of falsely negative results. 

However, there is another test that can be obtained from Webmed Pharmacy and this is the GBS-specific ECM(Enriched Culture Medium), which is the international ‘gold standard’ for detecting GBS. These tests are highly reliable and are good predictors of your GBS carriage status for 5 weeks after the swabs have been taken.  

Therefore, it’s best to test in the 5 weeks before you go into labour and give birth. The 35-37 week ‘window’ for testing is usually thought to be the best time to test for most people as your GBS carriage status is not likely to change between testing and giving birth, and you should receive the result before your baby arrives.

What are the symptoms of GBS?

If GBS infection is going to occur, it usually does within the first few hours of birth, but it may occur as late as when the baby is aged three months. Symptoms include:

• the baby becoming limp and floppy

• lack of response to stimuli

• a grunting noise when breathing

• high or low temperature

• rapid or slow breaths

• rapid or slow heartbeat

The appearance of any of these symptoms warrants a 999 call or an immediate visit to A&E. Time is of the essence as once the infection has taken hold, the difference between life and death can be a matter of hours. If the baby is diagnosed with GBS, they will be treated in hospital with antibiotics administered via a vein. (2)

How does GBS testing work?

If you’re pregnant and concerned about your baby contracting GBS, you can  consult your midwife or GP to help you decide whether to get tested. (2)

At Webmed Pharmacy, our testing kit allows you to take both a vaginal swab and a rectal swab to send off for testing (the above link takes you to the product specific page which explains the test in detail). If your results come back positive, you need to tell your midwife or GP. Your birth plan will need to be reconsidered if you’ve intended not to give birth in hospital. (2)

When you go into labour or your waters break, let your midwife know immediately. You will need regular injections of antibiotics into a vein throughout the labour. Any allergies to antibiotics must be reported to your midwife so they can ensure hospital staff administer a safe antibiotic for you. The hospital may want to keep a close eye on the newborn baby in case any signs of GBS infection arise, so you may need to stay in hospital for up to twelve hours after the birth as a precaution. If symptoms do appear, the baby will be given urgent antibiotics into a vein. (2)

For further information, visit the Group B Strep Support website.

Why take the risk - test now!

Click here to buy your Group B Strep test.

Author: Gabby Gallagher MPharm

Medically reviewed by: Superintendent Pharmacist Margaret Hudson BSc(Hons)MRPharmS 10/07/18

References

1. Group B Strep Support. What is group B Strep? [cited 6 July 2018]. Available at: https://gbss.org.uk/info-support/pregnancy-and-birth/what-is-group-b-strep/

2. NHS Choices. What is group B strep? [cited 6 July 2018]. Available at: https://www.nhs.uk/conditions/group-b-strep/

Viagra Connect is available to buy NOW!

Around 50% of men over the age of 40 suffer some form of erectile dysfunction.

This widespread condition can cause embarrassment, frustration and even depression for those affected. Some men are so ashamed about having erectile dysfunction that they choose not to seek help from their GP. They just continue to put up with the condition or more worryingly, opt to purchase treatment from illegal vendors online.

Purchasing any medicines in this way poses risks as there is no guarantee that they have been produced following the stringent quality and safety procedures and testing that medicines from UK registered and regulated online pharmacies undergo.

The good news is that this has impelled the Medicines and Healthcare products Regulatory Agency (MHRA) to reclassify Viagra Connect (sildenafil 50mg) from a prescription-only medicine (POM) to a pharmacy (P) medicine, meaning that it is available to purchase over the counter without a prescription in the UK from the spring of 2018. (1, 2)

Viagra Connect should be taken around one hour before sexual activity, ideally on an empty stomach as food can slow absorption. No more than a single tablet per day should be taken. Although the majority of men will be successful first time, it may take a few doses (therefore a few separate attempts) to reach the desired effect of a penile erection sufficient for satisfactory sexual activity. If this fails, you will need to see your GP. (3)

Men wishing to purchase Viagra Connect over the counter in a pharmacy will need to have a quick discussion surrounding symptoms, medical conditions and other medicines with the pharmacist, so that it can be determined whether the medicine is suitable or safe to take.

If buying from an online pharmacy, a short medical questionnaire will need to be completed to assess suitability. Certain medical conditions, such as cardiovascular diseases, high cardiovascular risk, and liver or kidney failure, may mean that the medicine cannot be sold and a GP appointment is needed. (2)

Viagra Connect is available to order from Webmed Pharmacy by selecting the medicine after clicking the ‘Treatments’ tab on the homepage. You will need to complete a short confidential online consultation, and then, like in any other pharmacy, the pharmacist will review the information you’ve given and assess whether the medicine is safe for you to take.

This regulatory change will benefit millions of UK men. For many, a trip to the pharmacy seems much more informal and is often more convenient than an appointment with the GP. The patient can even visit a pharmacy they don’t usually go to or use a General Pharmaceutical Council (GPhC) registered online pharmacy such as Webmed if they fear embarrassment. The danger to health of obtaining medicine from illegal, unregulated and unregistered websites will also be reduced. It may even help other underlying conditions to be diagnosed, since pharmacists will inform men buying Viagra Connect that they should make a follow-up appointment with their GP within 6 months so that such conditions can be tested for. (1)

Other options include:-

Viagra is the most well-known treatment for erectile dysfunction, often referred to as “the blue pill”.
The active ingredient in Viagra is sildenafil which dilates the blood vessels leading to the penis to enable a firm, long lasting erection when a man is sexually aroused or stimulated.

Viagra and Sildenafil both contain exactly the same active ingredient. They are both equally effective, but sildenafil is much cheaper.

Tadalafil, the generic form of Cialis, became available in November 2017 when the patent expired and has become very popular.

Tadalafil on demand is known as “the weekend pill” as, due to it's 36 hour duration of action, it can be taken on a Friday night and still be active on Sunday morning.

There is also a low dose tadalafil option taken on a daily basis, called Tadalafil daily, so you don’t have to plan ahead and can be ready for action “anytime, anyplace, anywhere”.

Worried about buying fake medicines online?  Then read our blog on what to look for to prove that it is a fully approved and Regulated pharmacy only supplying genuine UK sourced medication.

1. You’ll be able to buy Viagra for the first time ever- in the UK [cited 20 February 2018]. Viagra Connect to be available over the counter from Spring 2018. Available at: http://fortune.com/2017/11/28/viagra-over-the-counter-uk/

2. GOV.UK. MHRA reclassifies Viagra Connect tablets to a Pharmacy medicine [cited 20 February 2018]. Available at: https://www.gov.uk/government/news/mhra-reclassifies-viagra-connect-tablets-to-a-pharmacy-medicine

3. emc. Viagra Connect [cited 20 February 2018]. Available at: https://www.medicines.org.uk/emc/product/8725

   Author: Gabby Gallagher MPharm

   Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 09/07/18

The current heatwave in the UK has provided perfect conditions for a wide range of biting and stinging insects to thrive – and this has been demonstrated by the huge increase in medical help being sought for insect bites and their complications. Twice the usual number of calls to NHS Direct (111) have been made recently regarding this issue, and there has been a spike in hospital admissions to treat infected bites, particularly horsefly bites. (1)

In light of this news, this blog explores some of the most common insect bites and stings in the UK, highlighting what to look out for and how to manage them.

Horseflies are common in the UK, and as the name suggests they do bite horses, but also other mammals including humans. If you’ve been bitten by a horsefly you’ll know about it! That’s because not only do horseflies tend to ‘hone in’ on their targets by buzzing round them before finally finding a place on their body to land and bite, but their razor sharp mouthparts dig in to the skin, tearing rather than piercing it to extract as much blood as possible. This will be particularly painful and leave a nasty looking raised red bite which takes longer to heal than most other insect bites. Because of this, the bite can become infected. Look out for pus appearing in or from the bite, worsening pain, fever, or redness and swelling spreading from the bite to the surrounding areas – see your GP if you notice any of these symptoms as you may need treatment with antibiotics. (1, 2)

Mosquitoes are also abundant and particularly favour areas with standing water, such as those near lakes and ponds, but they can be found in other areas too. Generally, people do not realise they have been bitten by a mosquito until a rash develops, as their bite is painless. The bites appear as small red lumps which may contain fluid-filled sacs and can be intensely itchy. (1, 2)

Bees tend to keep themselves to themselves as they travel between flowers collecting pollen. They will usually only sting if they feel threatened. A sharp, piercing pain is felt and a small red mark may be left which often contains the bee sting. It is important that the sting is removed as soon as possible as it is venomous. Scrape the sting out using an object with a thin, hard edge, such as a bank card, or your fingernail. Do this in a sideways motion to draw the sting out of the wound. Don’t try to pluck or squeeze it out as this may release more venom into the surrounding tissue. (2, 3)

Wasps and hornets can be more bothersome, attacking people who are just keeping themselves to themselves! Also, they may sting more than once at a time. The sensation will be similar to a bee sting, but there is no sting left in the wound. Within hours, a red, painful and itchy lump can form around the sting wound, and in some cases the irritation and swelling can cover a considerable area for up to a week as part of a mild allergic reaction. (2)

Bee, wasp or hornet stings can occasionally cause serious allergic reactions (anaphylaxis). If you or someone around you begins to struggle breathing, experiences severe swelling on the face (mainly around the eyes and lips), or dizziness after being stung, call 999 immediately. (2)

Ticks are tiny spider-like creatures which can leave a small red, itchy bite and sometimes a blistered or bruised surrounding area. The bite doesn’t tend to cause any pain, so you may not notice you’ve been bitten. In the UK, ticks are generally harmless unless they carry Lyme disease (covered in more detail in an earlier blog), in which case a characteristic ‘bullseye’ rash may develop. See your GP if this happens.

To ease itching, apply calamine lotion or crotamiton cream to the bites or stings. You can also purchase hydrocortisone cream and antihistamines such as chlorphenamine or loratadine over the counter. Painkillers such as paracetamol can be taken to ease pain associated with stings or bites. Applying a cold compress to the affected area can help to reduce swelling. (3)

Continual scratching of the stung or bitten area can break the skin, which makes infection more likely. Signs of infection include pus or yellow crusting, spreading of the red and swollen area, worsening pain and fever. Don’t hesitate to contact your GP if this develops as you may need antibiotics to clear the infection.

If you’ve been stung or bitten in a sensitive area, such as inside the mouth or near the eyes, or if you experience worsening symptoms or see no improvement after a few days, see your GP or call NHS 111. (3)

To learn more, there is a great article called Bug Bite Identification - The 10 most common bug bites and how to identify them. It starts by explaining why bugs bite and then how to identify if you really have a bug bite. It goes on to venomous versus non venomous bites and when to seek medical attention. (4) 

References

1. Ives L (2018).Heatwave causes spike in insect bite calls to NHS [cited 18 July 2018]. Available at: https://www.bbc.co.uk/news/health-44823286

2. NHS Choices. Insect bites and stings – Symptoms [cited 18 July 2018]. Available at: https://www.nhs.uk/conditions/insect-bites-and-stings/symptoms

3. NHS Choices. Insect bites and stings – Treatment [cited 18 July 2018]. Available at: https://www.nhs.uk/conditions/insect-bites-and-stings/treatment

   4. Bug Bite Identification - The 10 most common bug bites and how to identify them. [cited 26 July 2020]. https://howigetridof.com/bug-bite-identification/

   Author: Gabby Gallagher MPharm

   Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 08/07/18

   Update: 21/11/20 by Margaret Hudson

We’re well into hay fever season which, for a fifth of the UK population, means relentless cold-like symptoms, headaches and general exhaustion. If this sounds all too familiar, it’s the perfect time to review the steps you can take to help reduce the intensity of your symptoms and make your day to day life easier! (1)

What is hay fever?

Hay fever, also known as seasonal allergic rhinitis, is a condition caused by the immune system’s reaction to pollen. Pollen is a fine powder produced by plants for the purpose of reproduction, and is easily carried by the air and therefore breathed in and deposited on hair, skin and clothes. (1)

Symptoms include sneezing, coughing, nasal congestion and running, reduced sense of smell, itching of the eyes, nose, throat and ears, headache and temple pain, earache and a lack of energy. Hay fever may also worsen asthma symptoms. (2)

Symptoms tend to be present for the whole hay fever season (March to September), particularly when the pollen count is high. This usually happens on hot and humid days with a breeze or wind. (2)

How is hay fever treated?

Antihistamines are the most common medical treatment for hay fever symptoms and can be purchased over the counter in pharmacies. They work by antagonising the effects of histamine, a chemical produced by the immune system in response to allergens. This will help with all symptoms. Over-the-counter antihistamines include chlorphenamine, acrivastine, cetirizine and loratadine and are available as tablets and oral solution. Chlorphenamine is a ‘drowsy’ antihistamine, so is useful for people who have trouble sleeping due to their symptoms, whereas acrivastine, cetirizine and loratadine are considered ‘non-drowsy’ and may be more suitable for daytime use, driving, working, school and exam time.

Other treatments that can be bought over the counter include steroid nasal sprays (beclometasone or fluticasone), decongestant nasal sprays (xylometazoline), and saline nasal sprays, which can help with stubborn congestion not relieved by antihistamines, and sodium cromoglicate eye drops to help specifically with itchy eyes.

If your symptoms still persist after trying medicines from the pharmacy, your GP can help. Other antihistamines unavailable over the counter, such as fexofenadine, can be prescribed, as can a wider range of stronger steroids in tablet or nasal spray form.

If this also fails, your GP may consider referring you to a specialist for immunotherapy treatment. This involves administering injections of low doses of pollen at regular intervals, usually starting around December time, to gradually build your immunity to pollen. Once hay fever season comes around, your body should have had enough exposure to no longer treat pollen as an allergen, therefore symptoms should not develop. Unfortunately, this is not a cure - you’ll need to have this done every year. (2)

What else can I do to help ease my hay fever symptoms?

Try to avoid going outside whenever possible, and particularly early in the morning and late in the afternoon/early evening. This is when pollen counts are highest. Also, avoid opening windows and doors in the house, and don’t allow outdoor pets in if possible. Vacuum daily if you can - consider investing in a vacuum incorporating a HEPA filter - and dust surfaces each day with a damp cloth. And although it seems obvious, don’t bring flowers into your house. (1, 2)

If you must go outside, create as many barriers as you can between you and the pollen! Protect your eyes with wraparound sunglasses, protect your airways by applying petroleum jelly around your nostrils, and stop pollen from getting into your car by attaching pollen filters to the air vents. Washing clothes, showering or bathing and washing hair after going outside will wash away any pollen stuck to you or your clothes. And don’t proceed to dry your clothes on the line - they’ll only become covered in pollen again! (2)

Stick to paths and pavements where possible, as walking on grass can release pollen into the air. Cutting grass also has this effect, so let someone else mow the lawn! (2)

Smoking and breathing in other people’s smoke can worsen hay fever symptoms, so avoid this at all costs. (2)

Click here for further information and support from Allergy UK.

References

1. BBC News. Tips for reducing hay fever symptoms [cited 12 June 2018]. Available at: https://www.bbc.co.uk/news/health-44381799
2. NHS Choices. Hay fever [cited 12 June 2018]. Available at: https://www.nhs.uk/conditions/hay-fever/

Author: Gabby Gallagher MPharm

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 13/06/18