Browse bulletin items by A-Z

Published: 14th June, 2024


New from bpacnz: Beta blockers for cardiovascular conditions: one size does not fit all

Although use has reduced in recent years, metoprolol succinate still accounts for more than half of all beta blockers dispensed in New Zealand. It is a reasonable choice if a cardioselective beta blocker is required, but there is little to no evidence that metoprolol succinate is more effective than other cardioselective beta blockers, such as bisoprolol. Depending on patient circumstances, a beta blocker with different properties, e.g. vasodilating, water-soluble, may be more appropriate. Prescribers are encouraged to consider the pharmacological diversity of beta blockers and clinical characteristics of patients when deciding which beta blocker to prescribe.

This is a revision of a previously published article and includes updated recommendations and new guidance on prescribing beta blockers to certain patient groups, e.g. those with diabetes, those who are pregnant or breast feeding. Evidence on the optimal treatment duration of beta blockers post-myocardial infarction has also been revised.

Read the full article here. A B-QuiCK summary is also available here.

New clinical audit: Identifying inappropriate anticholinergic medicine prescribing

A new clinical audit on identifying inappropriate anticholinergic medicine prescribing is now available on our website. The purpose of this audit is to assess anticholinergic burden in older patients who are prescribed anticholinergic medicines and determine if their current treatment is still appropriate.

Given the range of medical conditions that anticholinergic medicines are used for, each clinician is likely to have a number of patients who are being treated with these medicines; some for longer than is recommended or with a higher dose than is necessary. These patients may benefit from a dose reduction or deprescribing, depending on the clinical scenario and the patient’s therapeutic goals and treatment preferences. Patients who still require pharmacological management may benefit from switching to medicines with lower or no anticholinergic activity, if available. Non-pharmacological interventions should also be prioritised to reduce the required dose of, or overall need for, anticholinergic medicines.

View the audit here

For further information on anticholinergic burden in older people, see:

In case you missed it: other latest resources from bpacnz

June is Bowel Cancer Awareness Month

This month (June) is Bowel Cancer Awareness Month (resources available here). New Zealand has one of the highest rates of bowel cancer incidence in the world, and bowel cancer is the second highest cause of cancer mortality (behind lung cancer), with more than 1,200 deaths per year. Many people with bowel cancer are asymptomatic, and more than one-quarter of people have metastatic disease at the time of diagnosis.

Opportunistically check if eligible patients have received a bowel screening kit and identify and address any barriers to completing the test.

For information on the referral of patients with features suggestive of bowel cancer, see:

For information on the follow-up and surveillance for people after treatment for bowel cancer, and surveillance for people with polyps or inflammatory bowel disease, see: and

Medicine news: levetiracetam injections, morphine oral liquid, rivastigmine patches

The following news relating to medicine supply, of particular interest to primary care has recently been announced. Medicine supply information is also available in the New Zealand Formulary at the top of the individual monograph for any affected medicine and summarised here.

COVID-19 funding changes: RATs, PPE

An extension to the funding of rapid antigen tests (RATs) for COVID-19 testing has been announced. RATs will now be funded up until 30th September, 2024 (replacing the previous date of 30th June). Pharmacies and practices can continue to order RATs as usual (e.g. via the online portal process).

A list of available RAT collection sites is available here.

Health New Zealand, Te Whatu Ora, recently announced it is discontinuing COVID-19 personal protective equipment (PPE) products via Central Supply at the end of June, 2024. From July, healthcare providers will need to purchase PPE products via conventional channels.

N.B. It has been reported that changes to COVID-19 vaccine eligibility are being considered. However, Pharmac has confirmed that there will be no changes to vaccine eligibility from 1st July. Everyone aged five years and over remain eligible to receive COVID-19 vaccination (click here for further information). Children aged six months to four years who are at higher risk of severe illness from COVID-19 are also eligible. Additional doses are available for some people; click here for eligibility criteria.

Highly Pathogenic Avian Influenza

Human cases of Highly Pathogenic Avian Influenza (HPAI; also known as avian flu or bird flu) H5N1 remain rare but have been reported in some countries, e.g. Australia, United States of America. The H5N1 strain first originated in wild birds in the Northern Hemisphere, in 2021. There have been no cases reported in New Zealand in either animals or humans, but it is important to be aware of this virus, as public health preparedness strategies around the world begin to develop.

The main risk factor for human transmission is contact with infected animals, e.g. working with or around infected animals, travelling to an area with confirmed HPAI cases or consuming raw or undercooked meat from animals that are likely infected with HPAI. Person-to-person transmission is limited.

It is currently unlikely that primary care clinicians will see any cases of HPAI, but have a higher clinical suspicion for this in a patient who presents with respiratory symptoms (e.g. fever, chills, cough, sore throat), a history of recent travel to an outbreak area or contact with a potential source. Laboratory testing is required for diagnosis. All suspected cases of HPAI must be notified to the local Medical Officer of Health.

For further information, including diagnostic laboratory tests, see the Communicable Disease Manual (the HPAI chapter is currently under revision; further information will be released from Public Health as needed).

Latest edition of Prescriber Update released

The June edition of Prescriber Update has been published. Particular items of interest for primary care include:

View the full edition of Prescriber Update here

Vitamin D supplementation recommended for breast fed infants

Health New Zealand, Te Whatu Ora, has published an updated statement for healthcare professionals on vitamin D and sun exposure in pregnancy and infancy in New Zealand. The statement was first published in 2020, and includes information on recognising people who are at risk of vitamin D deficiency, when vitamin D supplementation is recommended and sun safety advice.

A significant change in the 2024 update is the recommendation that vitamin D supplementation be considered for all exclusively or partly* breast fed infants until age one year (previously supplementation was only recommended for breast fed infants with specific risk factors for deficiency). Another new recommendation is to consider vitamin D testing for pregnant people with multiple risk factors for deficiency.

*Infants receiving ≥ 500 mL of formula per day do not require supplementation

Read the full statement here. The statement is intended to be read in conjunction with the Consensus Statement on Vitamin D and Sun Exposure in New Zealand (2012).

Grants for Māori students enrolled in healthcare studies

Health New Zealand, Te Whatu Ora, has announced that applications for Te Pitomata (The Power of Potential) grants for this year are now open for Māori students enrolled in a range of healthcare studies, including medicine, dental, midwifery, nursing, allied health and Rongoā. Māori students enrolled in postgraduate health-related studies may also be eligible. The grants are intended to help with expanding the Māori health workforce. Further information on the grants, including how to apply, is available here. Applications close Sunday 16th June, 2024.

NZF updates for June

Significant changes to the NZF in the June, 2024, release include:

  • Cautions and patient advice updated in the zopiclone and benzodiazepine monographs (alprazolam, clonazepam, diazepam, lorazepam, midazolam, temazepam) regarding impairment of driving and skilled tasks
  • New indications added to the clonidine (neurology and endocrine) monograph: autonomic hyperactivity in abrupt opiate withdrawal (unapproved indication), analgesia (unapproved indication)
  • New patient advice added to the disulfiram monograph regarding the alcohol content of some medicines, foods and toiletry products
  • Cautions updated in the morphine salts monograph to include excipient information (Oramorph brand of morphine oral liquid contains ethanol)
  • Dosing regimen updated for dysmenorrhoea in the naproxen monograph
  • Indications, contraindications, advice in renal impairment, adverse effects and dosing regimen updated in the pseudoephedrine monograph. Sections on drug action and patient advice have also been added.
  • Promethazine is now contraindicated in children aged under six years (as reported in Bulletin 99). Adverse effects associated with promethazine use have been added for this age group.
    • In the NZFC, the dosing regimen for promethazine has also been updated (removal of dosing information for children aged under six years for motion sickness and symptomatic relief of allergy such as hayfever, insomnia associated with urticaria and pruritus) and is under review
  • Content reduced in the therapeutic notes in immunisation chapters for coronavirus disease (COVID-19) vaccines, influenza vaccines and meningococcal disease vaccines. Users are being advised to refer to the Immunisation Handbook for further information, available here. The remaining immunisation chapters will be updated over the coming months

You can read about all the changes in the June release here. Also read about any significant changes to the NZF for Children (NZFC), here.

Paper of the Week: Dietary interventions that can change the course of disease

It is well established that what we choose to eat and drink in our daily lives has a significant impact on our health. Many clinical conditions have some dietary component related to their development, e.g. obesity, type 2 diabetes, coronary artery disease and some cancers, and for some conditions, successful management is dependent on dietary modification, e.g. eliminating gluten for people with coeliac disease.

This week, two studies on the topic of diet and disease have been reviewed. Firstly, an article published in BMC Medicine examined the association between the Mediterranean diet and the development of microvascular complications relating to type 2 diabetes. A Mediterranean diet has previously been shown to reduce the risk of type 2 diabetes, however, this study showed that closer adherence to a Mediterranean diet by people who already have hyperglycaemia and/or type 2 diabetes is potentially protective against the development of diabetic nephropathy. Secondly, an article published in JAMA Dermatology investigated the degree to which dietary sodium intake is associated with atopic dermatitis. Consuming as little as 1 g above the daily recommended intake for sodium increases the odds of being diagnosed with atopic dermatitis, having active atopic dermatitis and having more severe atopic dermatitis. The findings from both these studies reinforce the role of diet in the management of chronic health conditions and could be discussed with patients at their next consultation.

Are there any dietary modifications you recommend for patients with conditions other than those discussed above? What evidence do you base these recommendations on? What strategies do you use to encourage adherence to dietary modifications?

This Bulletin is supported by the South Link Education Trust

If you have any information you would like us to add to our next bulletin, please email:

ASK A COLLEAGUE: Are they receiving these bulletins? Sign up to our mailing list here

© This resource is the subject of copyright which is owned by bpacnz. You may access it, but you may not reproduce it or any part of it except in the limited situations described in the terms of use on our website.

Made with by the bpacnz team

Partner links