RB Updates
Keeping you up-to-date
Here you’ll find information about RB’s latest campaigns and product launches along with mini-modules to help you brush up on your knowledge of new products or seasonal ranges. Don’t forget to check back here regularly!
Mini Module: Nurofen Equity
Within this short module you can find out about the safety and efficacy of ibuprofen and how this compares to other OTC analgesia.
Nurofen Express 400 mg Liquid Capsules: Each capsule, soft contains Ibuprofen 400 mg. Indications: for symptomatic relief of non-serious arthritic conditions, rheumatic or muscular pain, backache, neuralgia, migraine, headaches, dental pain, dysmenorrhoea, feverishness, colds and influenza. Dosage and Administration: Adults, the elderly and children and adolescents between 12 and 18 years: Take 1 capsule with water, up to three times a day as required. Leave at least 4 hours between doses. Do not take more than 3 capsules in any 24 hour period. Not for use by children under 12 years of age. If in children and adolescents this medicinal product is required for more than 3 days, or if symptoms worsen a doctor should be consulted. Adults should consult a doctor if symptoms persist or worsen, or if the product is required for more than 10 days. Contraindications: Known hypersensitivity to ibuprofen or other ingredients. Patients who have previously shown hypersensitivity reactions (e.g. asthma, rhinitis, angioderma or urticaria) in response to aspirin or other non-steroidal anti-inflammatory drugs. Active or history of recurrent peptic ulcer/haemorrhage (two or more distinct episodes of proven ulceration or bleeding). History of gastrointestinal bleeding or perforation, related to previous NSAIDs therapy. Severe heart failure (NYHA Class IV), renal failure or hepatic failure. Last trimester of pregnancy. Special warnings and precautions for use: The elderly have an increased frequency of adverse reactions to NSAIDs, especially gastrointestinal bleeding and perforation, which may be fatal. Respiratory: Bronchospasm may be precipitated in patients suffering from, or with a history of, bronchial asthma or allergic disease. Other NSAIDs: The use of ibuprofen with concomitant NSAIDs including cyclooxygenase-2 selective inhibitors should be avoided. SLE and mixed connective tissue disease: Systemic lupus erythematosus as well as those with mixed connective tissue disease – increased risk of aseptic meningitis. Renal: Renal impairment as renal function may further deteriorate. There is a risk of renal impairment in dehydrated children and adolescents. Hepatic: Hepatic dysfunction. Cardiovascular and cerebrovascular effects. Caution (discussion with doctor or pharmacist) is required prior to starting treatment in patients with a history of hypertension and/or heart failure as fluid retention, hypertension and oedema have been reported in association with NSAID therapy. Clinical studies suggest that use of ibuprofen, particularly at a high dose (2400mg/day) may be associated with a small increased risk of arterial thrombotic events (for example myocardial infarction or stroke). Overall, epidemiological studies do not suggest that low dose ibuprofen (e.g. £ 1200mg/day) is associated with an increased risk of arterial thrombotic events. Patients with uncontrolled hypertension, congestive heart failure (NYHA II-III), established ischaemic heart disease, peripheral arterial disease, and/or cerebrovascular disease should only be treated with ibuprofen after careful consideration and high doses (2400 mg/day) should be avoided. Careful consideration should also be exercised before initiating long-term treatment of patients with risk factors for cardiovascular events (e.g. hypertension, hyperlipidaemia, diabetes mellitus, and smoking), particularly if high doses of ibuprofen (2400 mg/day) are required. Impaired female fertility: There is limited evidence that drugs which inhibit cyclooxygenase/ prostaglandin synthesis may cause impairment of female fertility by an effect on ovulation. This is reversible upon withdrawal of treatment. Gastrointestinal: NSAIDs should be given with care to patients with a history of gastrointestinal disease (ulcerative colitis, Crohn’s disease) as these conditions may be exacerbated. GI bleeding, ulceration or perforation, which can be fatal has been reported with all NSAIDs at any time during treatment, with or without warning symptoms or a previous history of GI events. The risk of GI bleeding, ulceration or perforation is higher with increasing NSAID doses, in patients with a history of ulcer, particularly if complicated with haemorrhage or perforation, and in the elderly. These patients should commence treatment on the lowest dose available. Patients with a history of GI toxicity, particularly the elderly, should report any unusual abdominal symptoms (especially GI bleeding) particularly in the initial stages of treatment. Caution should be advised in patients receiving concomitant medications which could increase the risk of ulceration or bleeding, such as oral corticosteroids, anticoagulants such as warfarin, selective serotonin-reuptake inhibitors or antiplatelet agents such as aspirin. When GI bleeding or ulceration occurs in patients receiving ibuprofen, the treatment should be withdrawn. Dermatological: Serious skin reactions, some of them fatal, including exfoliative dermatitis, Stevens-Johnson syndrome and toxic epidermal necrolysis, have been reported very rarely in association with the use of NSAIDs. Patients appear to be at highest risk of these reactions early in the course of therapy, the onset of the reaction occurring in the majority of cases within the first month of treatment. Ibuprofen should be discontinued at the first appearance of skin rash, mucosal lesions, or any other sign of hypersensitivity. This medicine contains 27.9 mg potassium per capsule. To be taken into consideration by patients with reduced kidney function or patients on a controlled potassium diet. Contains Sorbitol. Patients with rare hereditary problems of fructose intolerance should not take this medicine. Also contains Ponceau 4R (E124) which may cause allergic reactions. Side effects: Hypersensitivity reactions including: (a) non-specific allergic reactions and anaphylaxis, (b) respiratory tract reactivity e.g. asthma, aggravated asthma, bronchospasm, dyspnoea, (c) various skin reactions e.g. pruritus, urticaria, purpura, angiodema and more rarely exfoliative and bullous dermatoses (including epidermal necrolysis and erythema multiforme). Gastrointestinal disturbance including: peptic ulcer, perforation or GI haemorrhage, headache, acute renal failure, liver disorders, and haematopoietic disorders including anaemia. Product Licence Number: PL 00063/0653. Licence Holder: Reckitt Benckiser Healthcare (UK) Ltd, SL1 4AQ. Legal category: P MRRP: £ 8.99 (20 capsules) Date: November 2015 – For full information refer to SPC: www.medicines.org.uk/emc/medicine/23384.
Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard. Adverse events should also be reported to Reckitt Benckiser Healthcare (UK) Ltd on: 03332005345
Mini Module: Guardium
Here you can find easy-to-digest learning about Guardium, a PPI that’s new to the makers of Gaviscon, for frequent heartburn.
GUARDIUM ACID REFLUX CONTROL 20MG GASTRO RESISTANT TABLETS (per tablet dose): esomeprazole 20mg. Indications: The short-term treatment of reflux symptoms (e.g. heartburn and acid regurgitation) in adults. Legal category: GSL. MAH: Reckitt Benckiser Healthcare (UK) Ltd, HU8 7DS, United Kingdom. Information about this product including adverse reactions, precautions, contra-indications and method of use can be found at: https://www.medicines.org.uk/emc/product/10345
Mini Module: Nurofen Medicated Plaster
This mini module guides you through musculoskeletal pain in pharmacy
and introduces the recently developed 24 hour Medicated Plaster from Nurofen.
Nurofen Joint & Muscular Pain Relief 200mg Medicated Plaster PL 00063/0733
Active Ingredient: Each medicated plaster contains 200 mg of ibuprofen. Indications: Nurofen Joint & Muscular Pain Relief 200mg Medicated Plaster is indicated for the short-term symptomatic treatment of local pain in acute muscular strains, or sprains in benign traumas close to the joint of the upper or lower limb in adults or adolescents aged 16 years and older. Dosage & Administration: Adults or adolescents aged 16 years and over: One dose is equal to one medicated plaster. The maximum dose for a single 24 hour period is one medicated plaster. The plaster can be applied at any time during the day or night but should be removed and a new plaster re-applied at the same time on the following day. The medicated plaster should be used for the shortest duration necessary to control symptoms. The treatment duration should not exceed 5 days. The therapeutic benefit of treatment longer than 5 days has not been established. If there is no improvement, during the recommended duration of treatment or a worsening of symptoms, a healthcare professional should be consulted. Elderly patients: No special dose adjustment is necessary. Paediatric population: The safety and efficacy of Nurofen Joint & Muscular Pain Relief 200mg Medicated Plaster in children or adolescents under 16 years of age has not yet been established. Method of administration: For cutaneous use and short-term use only. The medicated plaster should be used whole and not be cut. The medicated plaster should not be used together with an occlusive dressing. It is recommended to carefully wash and dry the area to be treated before applying the medicated plaster. Apply to intact skin only. Tear or cut the sachet along the dotted line to remove a medicated plaster. First remove the central portion of the release liner used to protect the adhesive surface and apply this surface to the painful area, once securely in place remove the remaining release liner at the edges of the plaster. The medicated plaster is flexible and conformable, and if necessary can be applied on or near a joint and will allow for normal movement. Avoid getting the medicated plaster wet. Contraindications: Hypersensitivity to the active substance or to any of the excipients listed in section 6.1. In patients who have previously shown hypersensitivity reactions (e.g. asthma, bronchospasm, rhinitis, angioedema or urticaria) in response to ibuprofen, acetylsalicylic acid or other non-steriodal anti-inflammatory drugs (NSAIDs). Application on broken or damaged skin Third trimester of pregnancy. Use on the eyes, lips or the mucous membranes. Warnings & Precautions: If symptoms persist for longer than 5 days or worsen, a healthcare professional should be consulted. Undesirable effects can be reduced by reducing the duration of treatment. Bronchospasm can occur in patients using ibuprofen who suffer or have previously suffered from bronchial asthma or allergies. The treatment should be discontinued immediately if a skin rash develops after applying the medicated plaster. Patients should be warned against exposure of the treated area to strong sources of natural and/or artificial light (e.g. tanning lamps) during treatment and for one day after removal of the medicated plaster, in order to reduce the risk of photosensitivity. Although the systemic availability of topically applied ibuprofen is significantly less than for oral dosage forms, complications may occur in rare cases. For these reasons, patients with: an impaired renal, cardiac or hepatic function; active or a history of peptic ulcer, intestinal inflammation or haemorrhagic diathesis should seek medical advice before using this medicinal product. Non-steroidal anti-inflammatory drugs should be used with caution in elderly patients, as they are more likely to experience undesirable effects. Pregnancy: The systemic concentration of ibuprofen is lower after topical administration, compared to oral formulations. With reference to experience from treatment with systemically applied NSAIDs, the following is recommended: Inhibition of prostaglandin synthesis may adversely affect the pregnancy and/or the embryo/foetal development. Data from epidemiological studies suggest an increased risk of miscarriage and of cardiac malformation and gastroschisis after use of a prostaglandin synthesis inhibitor in early pregnancy. The risk is believed to increase with dose and duration of therapy. In animals, administration of a prostaglandin synthesis inhibitor has been shown to result in increased pre- and post-implantation loss and embryo-foetal lethality. In addition, increased incidences of various malformations, including cardiovascular, have been reported in animals given a prostaglandin synthesis inhibitor during the organogenetic period. During the first and second trimester of pregnancy, Nurofen Joint & Muscular Pain Relief 200mg Medicated Plaster should not be given unless clearly necessary. If Nurofen Joint & Muscular Pain Relief 200mg Medicated Plaster is used during the first and second trimester of pregnancy, the dose should be kept as low and duration of treatment as short as possible. During the third trimester of pregnancy, all prostaglandin synthesis inhibitors may expose the foetus to: - cardiopulmonary toxicity (with premature closure of the ductus arteriosus and pulmonary hypertension); - renal dysfunction, which may progress to renal failure with oligo-hydroamniosis; the mother and the neonate, at the end of pregnancy, to: - possible prolongation of bleeding time, an anti-aggregating effect which may occur even at very low doses - inhibition of uterine contractions resulting in delayed or prolonged labour. Consequently, ibuprofen is contraindicated during the third trimester of pregnancy. Breast-feeding: After systemic application, only small amounts of ibuprofen and its metabolites pass into the breast milk. As no harmful effects to infants are known to date, it is not usually necessary to interrupt breast-feeding during short-term treatment with this medicated plaster at the recommended dose. However, as a precautionary measure, this medicated plaster should not be applied directly onto the breast area of women who are breast-feeding. Side effects: Systemic availability of topical ibuprofen is very low compared to orally administered NSAIDs. Adverse events, particularly those affecting the gastrointestinal tract, are less common with the use of topical ibuprofen. The list of the following adverse events relates to those experienced with topical ibuprofen at OTC (dose maximum 500 mg per day), in short term use. The following frequency conventions are used in the rating of undesirable effects: Very common (≥1/10); Common (≥1/100 to < 1/10); Uncommon (≥1/1,000 to < 1/100); Rare (≥1/10,000 to < 1/1,000); Very rare (< 1/10,000); Not known (cannot be estimated from the available data). Within each frequency grouping, adverse events are presented in order of decreasing seriousness.
|
System Organ Class |
Frequency |
Adverse Events |
|
Immune System Disorders |
Not known |
Hypersensitivity1 |
|
Gastrointestinal Disorders |
Not known |
Abdominal pain, dyspepsia |
|
Renal and Urinary Disorders |
Not known |
Renal impairment2 |
|
General Disorders and Administration Site conditions |
Not known |
Application site reaction3 |
Description of Selected Adverse Reactions: 1 Hypersensitivity reactions have been reported following treatment with oral ibuprofen. These may consist of (a) non-specific allergic reaction and anaphylaxis, (b) respiratory tract reactions comprising asthma, aggravated asthma, bronchospasm or dyspnoea, or (c) skin reactions, including rashes of various types, urticaria, purpura, angioedema and, more rarely, exfoliative and bullous dermatoses (including toxic epidermal necrolysis, Stevens-Johnson Syndrome and erythema multiforme), and pruritus. 2 Renal impairment may occur following the use of topical ibuprofen, particularly in those with pre-existing renal dysfunction. 3 The most common undesirable effects are application site reactions. Recommended retail price: £7.99 (pack of 2s); £12.99 (pack of 4s). Pack sizes available: 2,4,6,8 or 10 medicated plasters. Not all pack sizes may be marketed. Marketing Authorisation number: PL 00063/0733 Marketing Authorisation Holder: Reckitt Benckiser Healthcare UK Limited, 103-105 Bath Road, Slough, SL1 3UH, UK. Date of prep: May 18.
Adverse events should be reported. Reporting forms can be found at www.mhra.gov.uk/yellowcard.
Adverse events should also be reported to Reckitt Benckiser (0333 2005 345).
Mini Module: Strefen
This brief module explores viral and bacterial sore throats, the risks of antibiotic resistance and the deep-down action that can be offered by Strefen.
Name and actives: Strefen Honey & Lemon contains Flurbiprofen BP 8.75mg per lozenge.
Indication: Symptomatic relief of sore throat. Dosage and administration: Adults and children over the age of 12 years: One lozenge sucked/dissolved slowly in the mouth every 3 - 6 hours as required. Maximum 5 lozenges in a 24 hour period. The lowest effective dose should be used for the shortest duration necessary to relieve symptoms. The patient should consult a doctor if symptoms persist or worsen, or if the product is required for more than 3 days. It is recommended that this product should be used for a maximum of three days. Children: Not indicated for children under 12 years. Elderly: No dose modification is required. As with all lozenges, to avoid local irritation, Strefen Honey and Lemon should be moved around the mouth whilst sucking. Contraindications: Hypersensitivity to flurbiprofen or any of the excipients in the product. Patients who have previously shown hypersensitivity reactions (e.g. asthma, rhinitis, angioedema, or urticaria) in response to aspirin or other non-steroidal anti-inflammatory drugs. Active or history of recurrent peptic ulcer/haemorrhage (two or more distinct episodes of proven ulceration or bleeding). History of gastrointestinal bleeding or perforation, related to previous NSAIDS therapy. Severe heart failure, renal failure or hepatic failure. Last trimester of pregnancy. Special warnings and precautions for use: Pregnancy and lactation: Whilst no teratogenic effects have been demonstrated in animal experiments, the use of Strefen Honey and Lemon should, if possible, be avoided during the first 6 months of pregnancy. During the 3rd trimester, flurbiprofen is contraindicated as there is a risk of premature closure of the foetal ductus arteriosus with possible persistent pulmonary hypertension. The onset of labour may be delayed and the duration increased with an increased bleeding tendency in both mother and child. Flurbiprofen appears in the breast milk in very low concentration and is unlikely to affect the breast-fed infant adversely. Undesirable effects: Strefen Honey and Lemon have the potential for inducing transient local irritation of the buccal mucosa. The most frequently reported adverse event in clinical trials was taste perversion. Hypersensitivity reactions have been reported and these may consist of (a) non-specific allergic reactions and anaphylaxis (b) respiratory tract reactivity e.g. asthma, aggravated asthma, bronchospasm, dyspnoea (c) various skin reactions e.g. pruritus, urticaria, angioedema and more rarely exfoliative and bullous dermatoses (including epidermal necrolysis and erythema multiforme). The list of the following adverse effects relates to those experienced with NSAIDS at doses available over the counter for short-term use. In the treatment of chronic conditions, under long-term treatment, additional adverse effects may occur. Hypersensitivity reactions: Uncommon: Hypersensitivity reactions with urticaria and pruritis. Very rare: severe hypersensitivity reactions. Symptoms could be facial, tongue and laryngeal swelling, dyspnoea, tachycardia, hypotension, (anaphylaxis, angioedema or severe shock). Exacerbation of asthma and bronchospasm. Gastrointestinal: The most commonly observed adverse events are gastrointestinal in nature. Uncommon: abdominal pain, nausea, dyspepsia. Rare: Diarrhoea, flatulence, constipation and vomiting. Very rare: peptic ulcer, perforation or gastrointestinal haemorrhage, melaena, haematemesis, sometimes fatal, particularly in the elderly. Ulcerative stomatitis, gastritis. Exacerbation of colitis and Crohn’s disease. Nervous System: Uncommon: Headache. Very rare: Aseptic meningitis – single cases have been reported very rarely. Renal: Very rare: Acute renal failure, papillary necrosis, especially in long-term use, associated with increased serum and oedema. Hepatic: Very rare: liver disorders. Haematological: Very rare: Haematopoietic disorders (anaemia, leucopenia, thrombocytopenia, pancytopenia, agranulocytosis). First signs are fever, sore throat, superficial mouth ulcers, flu-like symptoms, severe exhaustion, unexplained bleeding and bruising. Dermatological: Uncommon: Various skin rashes. Very rare: Severe forms of skin reactions such as bullous reactions including Stevens-Johnson syndrome, erythema multiforme and toxic epidermal necrolysis can occur. Immune System: In patients with existing auto-immune disorders (such as systemic lupus erythematosus, mixed connective tissue disease) during treatment with ibuprofen, single cases of symptoms of aseptic meningitis, such as stiff neck, headache, nausea, vomiting, fever or disorientation have been observed (see section 4.4). Cardiovascular and Cerebrovascular Oedema, hypertension and cardiac failure, have been reported. In association with NSAID treatment. Clinical trial and epidemiological data suggest that the use of NSAIDS (particularly at high doses 2400 mg daily) and in long-term treatment may be associated with a small increased risk of arterial thrombotic events (for example myocardial infarction or stroke).
MRRP: £4.15 16 lozenges. Product license number: PL0327/0135. Product License Holder: Crookes Healthcare Ltd., Nottingham NG2 3AA. Legal category: P. Date of preparation: July 2017.
Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard.
Adverse events should also be reported to Reckitt Benckiser Healthcare (UK) Ltd on: 0333 200 5345.
Mini Module: Fungal Nail and Ingrowing Toenail
This bitesize mini-module introduces some recently developed treatments from Scholl that tackle two common footcare conditions you’ll see in your pharmacy: Fungal nail and ingrowing toenail.
SCHOLLMED ONCE WEEKLY FUNGAL NAIL TREATMENT 5% w/v MEDICATED NAIL LACQUER PL 00063/0740: Active Ingredients: Each 1ml solution contains 55.74 mg amorolfine hydrochloride (equivalent to 50 mg amorolfine). Indications: For the treatment of mild cases of distal and lateral subungual onychomycoses caused by dermatophytes, yeasts and moulds; treatment is limited to 2 nails. Dosage Instructions: For cutaneous use (application on the nail) in adults and elderly. Before the first application the affected areas of nail should be filed down and cleansed with an alcohol cleaning pad. The nail lacquer should be applied to the affected finger or toe nails once weekly. Before every weekly application nail should be cleanse with a cleaning pad and filed down as required. Not recommended for use in children and adolescents below 18 years. Contraindications: Hypersensitivity to the active substances(s) or to any of the ingredients. Precautions and Warnings: Avoid contact of the lacquer with eyes, ears and mucous membranes. Patients with underlying conditions predisposing to fungal nail infections should be referred to a doctor such conditions include peripheral circulatory disorders, diabetes mellitus, and immunosuppression. Patients with nail dystrophy and destroyed nail plate should be referred to their doctor. When working with organic solvents wear impermeable gloves in order to protect the amorolfine lacquer on the nails. During the application of scholl fungal nail 5% w/v medicated nail lacquer no cosmetic nail lacquer or artificial nails shall be used. Use of nail varnish or artificial nails should be avoided during treatment. Caution: Nail files used for affected nails must not be used for healthy nails. Treatment should be continued without interruption until the nail is regenerated and the affected areas are finally cured. Pregnancy and lactation: Amorolfine should be avoided during pregnancy and breastfeeding. Side effects: Rare: (≥1/10,000 to <1/1,000) patients may develop a nail disorder, nail discoloration, onychoclasis (broken nails) or onychorrhexis (brittle nails). Very rare: (<1/10,000) patients may experience skin burning sensation. Frequency unknown: Erythema, pruritus, contact dermatitis, urticaria, blisters. Product Licence Number: 00063/0740. Legal classification: Pharmacy only. Licence holder: Reckitt Benckiser Healthcare (UK) limited, 103-105 Bath Road, Slough, SL1 3UH, UK. MRRP: £23.99 (2.5ml medicated nail lacquer). Prepared July, 2017.
Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard. Adverse events should also be reported to Reckitt Benckiser Healthcare (UK) Ltd on: 0333 200 5345.
Mini Module: Gaviscon and your customers
This short module takes you through the Gaviscon heartburn and
indigestion range and which types of customers they are most suited to
so you can be more confident in your product recommendations.
GAVISCON ADVANCE ANISEED contains sodium alginate 500mg and potassium bicarbonate 100mg per 5ml dose. Indications: Treatment of symptoms resulting from the reflux of acid, bile and pepsin into the oesophagus such as acid regurgitation, heartburn, indigestion (occurring due to the reflux of stomach contents), for instance, after gastric surgery, as a result of hiatus hernia, during pregnancy, accompanying reflux oesophagitis, including symptoms of laryngopharyngeal reflux such as hoarseness and other voice disorders, sore throats and cough. Can also be used to treat the symptoms of gastro-oesophageal reflux during concomitant treatment with or following withdrawal of acid suppressing therapy. Legal category: P MRRP: 150ml - £4.99; 300ml - £8.99 MAH: Reckitt Benckiser Healthcare (UK) Ltd, HU8 7DS, United Kingdom. Information about this product including adverse reactions, precautions, contra-indications and method of use can be found at: www.medicines.org.uk/emc/medicine/20571
GAVISCON DOUBLE ACTION MINT contains sodium alginate 500mg, sodium bicarbonate 213mgl and calcium carbonate 325mg per 10ml dose Indications: Treatment of symptoms of gastro-oesophageal reflux such as acid regurgitation, heartburn and indigestion, for example following meals or during pregnancy, and for symptoms of excess stomach acid (hyperacidity). Legal category: GSL MRRP: 150ml - £4.99; 300ml - £8.49; 600ml - £13.99 MAH: Reckitt Benckiser Healthcare (UK) Ltd, HU8 7DS, United Kingdom. Information about this product including adverse reactions, precautions, contra-indications and method of use can be found at: www.medicines.org.uk/emc/medicine/23351
GAVISCON INFANT contains sodium alginate 225mg and magnesium alginate 87.5mg Indications: For gastric regurgitation, gastro-oesophageal reflux and reflux associated with hiatus hernia in infant and young children where competence of the cardiac sphincter has not been fully established. Legal category: P MRRP: £8.99 (30 unit doses) MAH: Reckitt Benckiser Healthcare (UK) Ltd, HU8 7DS. Information about this product including adverse reactions, precautions, contra-indications and method of use can be found at: www.medicines.org.uk/emc/medicine/21981
Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard. Adverse events should also be reported to Reckitt Benckiser Healthcare (UK) ltd on: 0333 200 5345.
