This document discusses self-medication in Croatia, including an overview of self-medication worldwide and in Croatia specifically. It notes that over-the-counter (OTC) drugs make up 27% of drugs used in Croatia by unit. The role of pharmacists is expanding to include health consultation to help patients practice responsible self-medication. Future goals include increasing education of both medical professionals and patients about responsible OTC drug use and the differences between OTC drugs and dietary supplements.

1. Vesna Marijanović Jukić, B.Pharm. Pharmacon 2007, Dubrovnik, May 26, 2007. SELF-MEDICATION IN CROATIA Where are we today and what is the future ?

2. OVERVIEW SELF-MEDICATION WORLDWIDE SELF-MEDICATION IN CROATIA CURRENT SITUATION FUTURE GOALS CONCLUSION

3. WHAT IS THE NEW SELF- MEDICATION CULTURE ? Patients: ● want to be informed about their drugs ● want to practice responsible self-care

4. WHAT IS SELF - CARE ? what people do for themselves to maintain or improve their health and solve health problems It consists of: hygiene nutrition lifestyle living standard self-medication

5. RESPONSIBLE SELF- MEDICATION ● very important role in health improvement and well-being of each person ● large influence on population health in each country.

6. OTC PRODUCTS WHAT IS OTC PRODUCT? ("over-the-counter") OTC DRUGS – sale without MD prescription: - sintethic origin - herbal origin well-established substances large therapeutic width - low risk of inedaquate usage - very common indications packaging: adapted to short-term treatment - minor illnesses COSMETICS with special purpose (menthol..) DIETETIC PRODUCTS food supplements with special purpose ( NOT functional food )

7. SELF-MEDICATION WORLDWIDE (USA / EUROPE)

8. TOP 10 OTC COMPANIES WORLDWIDE Sanofi-Aventis 10 Boehringer Ingleheim 9 Taisho 8 Procter & Gamble 7 Novartis 6 Wyeth 5 GlaxoSmithKline 4 Pfizer 3 Bayer 2 Johnson & Johnson 1 COMPANY

9. 2005. 5. DERMATOLOGIC PRODUCT 4. GASTRO PRODUCTS 3. VITAMINS & MINERALS 2. COUGH/COLD/ALLERGY 1. ANALGETICS TOP 5 OTC PRODUCT CATEGORIES

10. Global OTC market constantly grows Global OTC market, 2001-2007, billion $ Self-medication more and more used for chronic diseases, not only for prevention and minor illnesses. Pharmacist has most important role. Lifestyle products improve quality of life by improving unwanted conditions that affect everyday life (not diseases in need for medical treatment) Reuters Business Insight, The OTC Outlook to 2007 6,5% CAGR

11. OTC drugs used for more indications USA: 80 categories of OTC drugs. 100.000 OTC drugs on the market, but only 1.000 different substances – combination is important - hard to develop new drug– line extensions, new tastes, new forms.... OTC market USA, 2003, total: $16,098 mil

12. Patients - different attitudes on certain aspects of their health For which problems would an OTC product be your first choice? Source: Datamonitor 2004 Patients: better informed, more concerned about self-medication OTC drug became first choice for cough & cold (USA consumers, % of answers, 2004.)

13. GROWING HEALTH PROBLEMS LIFESTYLE: impotency,overweight,hair loss NERVOUS SYSTEM & DEPRESSION CARDIOVASCULAR PROBLEMS ANTIBIOTIC RESISTENCE ALZHEIMER /MEMORY OVERWEIGHT / DIABETES WELLNESS / HEALTH PREVENTION

14. GROWING HEALTH PROBLEMS Alzheimer disease High blood presure Overweight Cognitive abbilities Energy loss Overweight Menopause Hyperactivity amblyopia ( low vision ) Diabetes High colesterol Physical condition Arthrytis High blood presure Cancer Energy loss Malnutrition Arthrytis High colesterol Breast cancer Overweight OLDER PEOPLE MEN WOMEN CHILDREN/ TEENAGER

15. ROLE OF PHARMACIST TODAY TODAY... HEALTH CONSULTANT – personal consultant for each patient MORE QUALIFIED EXPERT – higher education in pharmacotherapy; more focused on therapy evaluation and results of treatment NEW SKILLS (active listening, psychological & communication skills) GOAL: to transfer principals of quality and responsible drug usage to the patient/consumer RECENTLY... focused on ethical drugs (Rx) – safe issuing and preparation of drugs

16. PHARMACIST ROLE IN SELF- MEDICATION Self-medication responsibility transfered to consumer OTC drugs available in supermarkets, gas-stations Internet drug sale expanded less important role than in Europe USA most important & most responsible role in safe usage of OTC drugs and further development of OTC market Pharmaceutical industry: primary partner to pharmacists & MD EUROPE & CROATIA

17. Rx  OTC "switching" (extending of product life-cycle) PATENT EXPIRY moment for BRANDED DRUGS Product substitutes Price lowering Decrease of market share Sale reduction by 80% STRATEGIES for SALE MAXIMISING and lowering of COMPETITON influence New indications Launch of generics Re-launch Rx- OTC switch Reformulation Leaving market Competition entrance

18. only drugs with well-established use & good safety profile EUROPE - national specific attitudes ! RECENT SWITCHES: simvastatin (Zocor Heart-Pro),levonorgestrele (contraception) CROATIA large progress – BELUPO Inc. leader in switching ! paracetamole (LUPOCET) , loratadine (BELODIN), ibuprofene (NEOFEN), aciclovire (HERPLEX),omeprazole (TARGET), dextrometrophane (TABEX), lactulose (PORTALAK) SUCCESS OF OTC DRUG AFTER SWITCHING DEPENDS ON PHARMACISTS SUPPORT !

19. SELF – MEDICATION IN CROATIA CURRENT SITUATION

20. OTC PRODUCTS OTC PRODUCTS IN CROATIA OTC DRUGS sintethic origin - 136 herbal origin - 28 COSMETICS with special purpose ( 320 ) DIETETIC PRODUCTS food supplements with special purpose (2.176) SOURCE : PHARMIS, 2005 56% 77% OTC DRUGS 44 % 23 % DIETETIC P. by value (kn) by unit OTC products sales

21. SOURCE : PHARMIS predicted growth: 5-10% / year

22. OTC MARKET IN CROATIA OTC costs / consumer: 120 kn / month ( 16 EUR) 7 packages/year or ½ package/month OTC drugs are 27% of all drugs (by unit) Europe=60% is OTC

23. SOURCE : PHARMIS 10 LARGEST OTC COMPANIES 2006 . 2,5 % MENTHOLATUM 10 4,6 % KRKA 9 4,6 % JGL 8 6,5 % LEK 7 6,6 % BAYER 6 8,3 % DIETPHARM 5 8,4 % OKTAL PHARMA 4 10 % NATURAL WEALTH 3 11 % BELUPO 2 15 % PLIVA 1 MARKET SHARE rang

24. OTC DRUGS USAGE IN CROATIA OTC drugs mostly used: analgetics, cough & cold... Source: Market research on BELUPO MARKET VALUE, ACCENT, Zagreb, 09/ 2006. 84 55 54 19 12 5 2 1 1 1 5 10 0 20 40 60 80 100 ANALGETICS ANTIPERITCS COLD, FLU COUGH CIRCULATION CV PREVENTION ANTACIDS ALLERGY Tegobe prostate LIVER protect OTHER do not use

25. TOP 10 OTC PRODUCTS 2006. (kn) SOURCE : PHARMIS, 2006 STREPSILS ( amilmetakrezol, 2,4-di c lorobenzil al c ohol , BOOTS H.) 10 DEEP RELIEF ( ibuprofene/menthol, OKTAL P.) 9 ASPIRIN C (BAYER) 8 LEKADOL ( paracetamole , KRKA) 7 LUPOCET ( paracetamole, BELUPO) 6 OPERIL ( oxymethasoline, LEK) 5 GINKGO BELUPO 4 PLIVADON ( codeine/coffeine/paracetamol/propiphenasone, PLIVA) 3 CAFFETIN ( codeine/coffeine/paracetamol/propiphenasone, ALKALOID) 2 ANDOL 100 (PLIVA) 1

26. "NEW AGE" CONSUMER / PATIENT 1. TIME - more valid than money! everything 24h available (shops 7days, ATM machines24h) less sleeping (to do more) 40% forget their doctor appointment (UK) 2. MULTIPLE CHOICES confuse consumers (multiple products,services) 3. WELL-BEING better living standard (EU); ready to pay more for higher value product 4. NEW MEDIA & TECHNOLOGIES more communication possibilities & information access more “on-line” consumers, less TV CONSUMERS IN CROATIA: - 700.000 people without primary school 60% OTC users older than 65 years

27. “ MODERN” DISEASES that could be reduced by OTC products SMOKING 34% men 27% women ALCOHOLISM average consumption 11 L / year (adults) problem of juvenile alcoholism DRUG ABUSE young people < 18, more and more often ! OVERWEIGHT 17% men 15% women &quot;WORK&quot; ILLNESSES 4 cases in 100 000 inhabitans

28. BELUPO OTC PRODUCTS ( 33 products – herbal drugs, synthetic and dietary supplements) PRODUCT CATEGORIES Imuno-cardiovascular Cough,cold, allergy Analgetics Gastro- metaboliic Urogenital Antidepressants Dermatics UROSAL, UROSAL LADY, UROSAL M HERPLEX, FLOCETA, BEVITAL, BEVITAL SUN SYLIMARIN, FITOLAX, BELOMET AKTIVIN-H LUPOCET, LUBORETA, NEOFEN, NEOFEN FORTE TABEX, FAVORA SYRUPS, EUSIN, BELODIN GINKGO, MAXI –OMEGA, FERSAN, VITASENG Overweight GO SLIM, FIT-LAX

29. SPECIFIC ISSUES IN CROATIA 60% OTC users older than 65 years OTC drugs are only 27% of all drugs OTC drug – pharmacy only , not in drugstore same herbal substance can be registrated as OTC drug or dietetic supplement: inadequate dosage regimen ► inadequate treatment MDs – negative opinion on herbal OTC drugs

30. HOW IMPORTANT ARE PHARMACIES IN SELF- MEDICATION? THEY OFFER MANY PRODUCTS & HEALTH ADVISE SERVICE in order to PROMOTE HEALTH PREVENTION IMPORTANCE ! EASY WAY FOR PATIENT TO GET HEALTH ADVICE ! easier than in hospital, ambulants – without administration bariers BETTER PERSONAL CONTACT WITH PATIENT OPEN COMMUNICATION VERY IMPORTANT !

31. SOURCE: 1000 people, MEDIA METAR, VEČERNJI LIST, 23.10.2004.

32. WHAT IS PHARMACISTS ROLE IN PATIENT EDUCATION ON SELF – MEDICATION ? They are RESPONSIBLE to EDUCATE PATIENT on: - recommended OTC drug - how and for how long it should be used - how should it be stored - therapy evaluation & results - possible interactions

33. WHAT IS THE DIFFERENCE BETWEEN OTC DRUG & DIETETIC PRODUCT ? HERBAL OTC DRUG registration: 2 years proven efficacy pharmacokinetics known pharmacodinamics known clinical studies available DIETETIC PRODUCT registration:1-2 month food supplement confirmation on safety issue PHARMACIST SHOULD EMPHASIZE THE DIFFERENCE !

34. SOURCE: 1. 1000 people, MEDIA METAR, VEČERNJI LIST, 23.10.2004. WHAT IS MOST IMPORTANT TO PATIENT ABOUT OTC DRUG?

35. FUTURE GOALS for OTC & CONCLUSION

36. ROLE OF PHARMACEUTICAL INDUSTRY IN SELF - MEDICATION INVEST IN QUALITY of PRODUCTS & SERVICES production control, highly expert personel emphasizing the difference between OTC drug & same dietetic product patient-friendly leaflets, side-effects, interactions pharmacy-only OTC drugs CONTINUOUS EDUCATION of MDs & PHARMACISTS MD – herbal drug– clinical studies – side-effects – interactions PATIENT EDUCATION about prevention, responsible self-medication, diseases explain the media manipulation more education, less promotion & advertising

37. IMPORTANCE OF FURTHER DEVELOPMENT OF SELF - MEDICATION COUNTRY BENEFITS reduces the expenses of health budget (less prescriptions) DOCTOR BENEFITS - can have more time for serious health problems PATIENT BENEFITS - learns to take care about his/her health – prevention ! - only satisfied patient accepts self-medication as quality choice that is easier to have in pharmacy than in other health institutions

38. CONCLUSION OTC has influence on population health, economical benefits for country are not neglectable !

39. CONCLUSION In order to further develop self-medication it is needed to have appropriate Rx to OTC switching, innovative OTC products, &quot;patient friendly&quot; information leaflets, proactive and highly educated pharmacists, as well as collaborative role of MDs in health-care system !

40. THANK YOU FOR YOUR ATTENTION !