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Published: 17th October, 2025
Contents
New from bpacnz – COVID-19 antivirals: Eligibility and prescribing guidance
A comprehensive article about COVID-19 antivirals is now available from bpacnz. This article explains the access criteria for funded antiviral treatment, including detailed information about factors that increase the risk of severe outcomes from COVID-19. Guidance is provided on nirmatrelvir/ritonavir (Paxlovid) dosing, medicine interactions and adverse effects, and evidence of effectiveness is discussed. A recent change that prescribers may not be aware of is that Paxlovid is no longer contraindicated in patients with an eGFR < 30 mL/min/1.73 m2 (the datasheet was updated in September). Lower doses are prescribed for patients with an eGFR < 60 mL/min/1.73 m2.
Amendments were made to the access criteria for funded COVID-19 antivirals for people aged 50 – 64 years from 1st September, 2025. All people aged 50 years and over with COVID-19 who are considered by their healthcare professional to be at high risk of hospitalisation or death from COVID-19 are now eligible for funded treatment (as reported in Bulletin 130). Healthcare professionals are advised to use their clinical judgement, including knowledge of COVID-19 epidemiology and risk factors, to prescribe COVID-19 antivirals to patients aged ≥ 50 years based on need.
View the full article here. A B-QuiCK summary is also available.
A summary of access criteria for COVID-19 antivirals was published in advance last month, to provide prescribers with rapid guidance to align with the changes (as reported in Bulletin 131). This summary remains available; however, the full article also covers this information in more detail.
In case you missed it:
Treatment resistant atopic dermatitis in adults and adolescents: a topical issue
Most people with atopic dermatitis achieve adequate symptom control with regular emollient and topical corticosteroid use. However, some people do not respond to conventional management and require additional treatments. Upadacitinib, an oral Janus-kinase inhibitor, is now funded for patients with moderate to severe atopic dermatitis who meet Special Authority criteria.
Upadacitinib has a faster onset and a different mechanism of action than many other immunosuppressants used for atopic dermatitis and has demonstrated considerable efficacy in clinical trials. Special Authority applications can be made by any relevant practitioner, providing another option in the community for patients with treatment resistant atopic dermatitis.
View the full article here. A B-QuiCK summary is also available.
Revised: Clinical Audit – Reviewing asthma treatment in adolescents and adults
bpacnz recently published an updated version of the popular clinical audit for asthma (as reported in Bulletin 133). This audit focuses on identifying patients who continue to be prescribed a SABA reliever with maintenance ICS who may benefit from a switch to AIR therapy.
In response to feedback, we have made some revisions to the audit to ensure that it also addresses concurrent prescription of a SABA reliever for patients prescribed AIR therapy, which is not best practice. Co-prescribing may result in continued reliance on a SABA reliever, undermining the clinical benefits of AIR therapy and increasing the risk of adverse effects due to SABA overuse. If a patient cannot, or does not want to, be prescribed AIR therapy, a SABA reliever is still appropriate, but this must be prescribed alongside maintenance inhaled corticosteroid therapy.
The audit identifies all people aged ≥ 12 years with a diagnosis of asthma, to check whether they are prescribed AIR therapy (if so, this is a positive result). If they are prescribed a SABA concurrently with AIR therapy, or alone, i.e. without maintenance ICS treatment, this is not considered a positive result. Patients not currently prescribed AIR therapy or inappropriately prescribed a SABA, should be flagged for review to ensure their treatment is consistent with the Asthma and Respiratory Foundation NZ Adolescent & Adult Asthma Guidelines.
Options are also available for a Working Audit.
View the revised audit here.
For further information on the pharmacological management of asthma in adolescents and adults, see: https://bpac.org.nz/2020/asthma.aspx
All bpacnz online resources are dynamic and feedback that supports resource refinement is welcome. Feedback or questions can be emailed to: editor@bpac.org.nz.
Rewind: Wrap-up of recent key messages
Key dates and news items from recent editions of Best Practice Bulletin:
- Pharmac has announced that access to ticagrelor will be widened from 1st November to include patients with a minor stroke or high-risk TIA for whom clopidogrel is not clinically appropriate. This decision was made following consultation on a proposal; see Bulletin 131 for further information.
- The HealthPathways webinar on abnormal uterine bleeding has been postponed. It will now be held on Tuesday, 31st March, 2026, from 7 pm. See Bulletin 132 for further information.
- Pharmac is proposing changes to increase access to HIV medicines. Consultation closes Monday, 20th October, 2025. See Bulletin 133 for further information.
- The number of measles cases in New Zealand has risen to 13, with an additional three cases in Northland (total 12 cases) since last reported in Bulletin 133. There has been no increase on the one case in Queenstown. View the update from Health NZ here.
- Stock of the FreeStyle Libre 2 model of continuous glucose monitor is expected to run out in November, 2025. Patients can be switched to the FreeStyle Libre 2 Plus. See Bulletin 128 for further information.
Pharmaceutical Schedule changes to support extended prescription lengths + removal of some Special Authority renewals
Pharmac has announced changes that will be made to the Pharmaceutical Schedule to support increased prescription lengths, following consultation (as reported in Bulletin 126). This is in response to the Government’s decision to extend the maximum prescription length to 12 months (the original proposal was reported in Bulletin 110).
Determining the appropriate prescription duration remains the responsibility of the prescriber and these changes (below) will not apply to controlled drugs. Patients will still only be able to collect a maximum three-months supply of their medicine at one time on a 12-month prescription, i.e. one initial dispensing and three repeat dispensings, or a six-month supply of oral contraceptives.
Key changes from 1st February, 2026:
- Funding restrictions on some medicines, medical devices and consumables will change from a per-prescription limit to a per-treatment period limit, e.g. 1.8 mg liraglutide (0.1 prefilled injection pen) per day will be funded, instead of the current limit of three cartridges per month or nine per prescription
- The Special Authority approval periods for some medicines will be extended to ensure that the full treatment course can be dispensed prior to expiry of the approval
- Up to three months’ supply can be dispensed as long as the first dispensing was before the Special Authority expiry date. N.B. This is a change from the original proposal that would have limited funding to dispensings made before the date of Special Authority expiry, independent of the prescription length.
View all the upcoming changes to the Pharmaceutical Schedule and the products they apply to here.
Some Special Authority renewals to be removed from 1st December, 2025
To align with the upcoming changes, and as a result of feedback on the proposal, the Special Authority renewal requirements are to be removed from specific medicines and medical devices from 1st December, 2025. New patients will still require an initial Special Authority application. These include:
- Insulin pumps and continuous glucose monitors (interoperable and standalone) for type 1 diabetes
- Long-acting muscarinic antagonists with long-acting beta2-agonists (LAMA/LABA inhalers) for respiratory conditions
- Febuxostat for gout
- Budesonide capsules for Crohn’s disease and microscopic colitis
- Epoetin alfa for chronic renal failure
Pharmac is working to extend expiry dates for people with current Special Authority approvals that will be affected by these changes.
Medicine news
The following news relating to medicine supply has recently been announced. These items are selected based on their relevance to primary care and where issues for patients are anticipated, e.g. no alternative medicine available or changing to the alternative presents issues. Information about medicine supply is available in the New Zealand Formulary at the top of the individual monograph for any affected medicine and summarised here.
Candesartan 32 mg tablets out of stock
The supplier of candesartan cilexetil (Candestar) is out of stock of 32 mg tablets due to factory delays; there may still be some stock in the supply chain. Other strengths are currently unaffected. Pharmacists can dispense 2 x 16 mg tablets in the interim until new stock arrives at the end of October; some patients may require additional guidance to ensure they understand this temporary change in dosing.
Funding issues affecting fexofenadine 60 mg tablets and levocabastine eye drops
Two separate funding changes are temporarily affecting the Telfast brand of fexofenadine 60 mg tablets and levocabastine (Livostin) eye drops. Both of these products (partly funded) have undergone minor packaging changes, meaning they do not match the products listed on the Pharmaceutical Schedule and therefore cannot be claimed for. Pharmacies dispensing the newly packaged products will have to charge the patient the full price, or a prescription for an alternative funded product will be required. Both the newly packaged fexofenadine tablets and levocabastine eye drops will be listed on the Pharmaceutical Schedule from 1st November, and will be partly funded again.
Oxycodone immediate-release tablets supply issue update
Supply issues affecting oxycodone immediate-release tablets remain ongoing (as last reported in Bulletin 129). The supplier is currently out of stock of 5 mg tablets, and stock of 10 mg and 20 mg tablets is low (some pharmacies may not be able to source stock). Re-supply of all strengths has been delayed until mid-to-late October (previously expected in September). Check the Pharmac website for up-to-date information or contact the patient’s regular pharmacy prior to issuing a prescription (or the patient can check if stock is available before collecting). Oxycodone 1 mg/mL oral liquid is available (a new prescription will be required), but clinicians are advised to consider prescribing an alternative analgesic.
Rizatriptan (Rizamelt) in limited supply
A supply issue affecting rizatriptan (Rizamelt) has been announced. Stock of rizatriptan 10 mg orodispersible tablets is low due to factory delays and increased demand. Re-supply is expected in late October, but stock will take some time to reach pharmacies. Pharmac has not been able to source an alternative brand of rizatriptan at this stage. Prescribers are being advised to consider prescribing a different medicine, e.g. sumatriptan, for patients with acute migraine (see NZF for funded alternatives and dosing instructions); a new prescription will be required.
Further information on the management of migraine in primary care is available, here (this article was published in 2017; some information may be out of date).
Supply issue affecting hydrocortisone with miconazole (Micreme H)
The supplier of hydrocortisone with miconazole (Micreme H) has advised that stock of this medicine will expire at the end of November. It is not currently known when new stock will be available. Patients who are unable to access Micreme H will need to be prescribed an alternative antifungal preparation, or both miconazole and hydrocortisone cream as separate items on a prescription.
Updated melanoma guidelines out for consultation
The National Melanoma Working Group and the Melanoma Network of New Zealand are seeking feedback on revised melanoma guidelines. The guidelines have been renamed from Quality Statements to Guide Melanoma Diagnosis and Treatment in New Zealand to New Zealand Melanoma Clinical Guidelines and aim to define what quality care for melanoma should look like in New Zealand, covering prevention, early detection and staging, right through to treatment, follow-up and surveillance.
View the updated guidelines here. A list of proposed changes is also available here. Consultation closes Friday, 24th October, 2025. Click here for information on how to submit feedback.
Invitation to participate in a survey about implementation of asthma guidelines
Three general practitioners working at the Medical Research Institute of New Zealand (MRINZ) are investigating how the New Zealand asthma guidelines are being translated into general practice, and if there are any barriers to implementation.
Peer groups are invited to take part in a survey about implementation of the asthma guidelines; the survey is expected to take 20 – 30 minutes. This can be facilitated by the research team either in person or via Zoom, or by the peer group convenor. To recognise the time involved, a $50 reimbursement will be available to everyone who completes the survey. Optional discussion questions or education resources related to asthma can be provided for the rest of the peer review session.
Contact Dr Rebekah Lamb (rebekah.lamb@mrinz.ac.nz) for more information if you are interested in taking part.
Podcast of the Week: Perinatal mental health – how primary care can help families cope
A recent episode of The Good GP, an Australian podcast series, discusses the topic of perinatal mental health which covers the entire period from pre-conception, pregnancy itself and the first year post-partum. Postnatal depression impacts the whole family; it is estimated to affect one in five mothers and one in ten fathers. However, perinatal mental health encompasses more than just postnatal depression. It includes pre-existing mental health conditions that have been exacerbated during pregnancy, first presentations of depression, anxiety or OCD, PTSD, birth trauma and post-partum psychosis.
The speakers in this podcast highlight the practical things that can be done in primary care for parents and families during the perinatal period. Early identification and intervention are vital. Every contact with parents during antenatal and postnatal visits can provide an opportunity to check how things are going – sometimes just asking that question can be a great start.
Read more
- Untreated perinatal mental health conditions can disrupt family bonding with the new baby and heighten relationship stress increasing the risk of relationship breakdown
- There can also be direct effects on the confidence of new parents sometimes resulting in a withdrawal from wider society and isolation
- Increased vulnerability of new parents can result in both physical and emotional problems for the child
- Aim to validate any concerns that are mentioned. If things are going well, consider providing some non-judgmental education, e.g. “It’s fantastic that you’re doing great, but I let all my new parents know that it can be quite common to struggle in this period…”.
- Address sleep deprivation – a universal problem that comes with a new baby
- Reinforce the “team” aspect of relationships so that one parent is not carrying the entire load
- Suggest taking up any offers of support from the wider family and community
- Discuss embracing change – just when you thought things were sorted, something will change. However, also remind parents that change is not always for the worse!
- Important: check for red flags – depressed mood lasting for longer periods (“most of the day, most of the time”), struggling to find any enjoyment, being alert to any disconnect (not bonding well with the baby)
- Book a follow-up appointment to keep communication going if there are any concerns
- Parents with previous mental health problems during pregnancy or in the postnatal period are at increased risk of problems in subsequent pregnancies
- Initiating conversations early and proactive planning is advised in these situations
Listen to the podcast here (20 minutes; skip ahead to ‘2.28’ for the main content).
For further information on perinatal depression, see: https://bpac.org.nz/2019/perinatal-depression.aspx
Did you know bpacnz podcasts are now available on Apple Podcasts and Spotify?
Both our Recovery at Work podcast and Last Days of Life podcast can now be streamed on Apple Podcasts and Spotify. We plan to add more resources to these platforms in the future. Watch this space!
Paper of the Week: Food for thought – quality of diet influences chronic pain
Chronic pain is a frequently encountered symptom in primary care consultations. Its aetiology is often multifaceted, and management requires balancing both pharmacological and non-pharmacological interventions. People with chronic pain who have increased adiposity may benefit clinically from weight loss; a discussion regarding lifestyle interventions encompassing dietary changes can therefore be valuable. Elevated body mass index (BMI) can increase the risk of lower limb stress and biomechanical changes and result in chronic musculoskeletal pain. There is also evidence to suggest adipose tissue promotes chronic inflammation, potentiating pain caused by mechanical stress. Conventional dietary interventions prioritise energy restriction via reducing caloric intake. This approach has the potential for detrimental effects, e.g. nutritional deficiency, if not managed appropriately. What if, instead of restricting quantity, we shifted focus to the quality of food consumed?
A study published in the European Journal of Nutrition investigated whether a dietary intervention with an additional focus on improving the quality of food consumed by participants resulted in weight loss or affected chronic musculoskeletal pain. After three months, participants had an average weight reduction of approximately 7 kg alongside a 22% improvement in diet quality, i.e. increased intake of fruits, vegetables, whole grains and lean meats, while limiting alcohol and unsaturated fats - similar to the Mediterranean diet. Over the same period, the number of participants reporting chronic musculoskeletal pain reduced from 50% to 24%. While not all observed improvements in pain measures could be explained by an improvement in diet quality and further investigations are required, these results suggest that for some people, what they are eating, may be as important as how much they are eating when it comes to reducing the severity of their chronic musculoskeletal pain.
When recommending dietary interventions to patients, do you solely focus on calorie reduction, or do you also incorporate the importance of food quality into the conversation? Do you specifically discuss diet with patients who experience chronic musculoskeletal pain? What other non-pharmacological interventions do you recommend?
Read more
- This study involved secondary analysis of an Australian-based randomised controlled trial. From the original study, a total of 104 participants (70% female) aged 25 – 65 years with a BMI range of 27.5 – 34.9 kg/m2 completed a three-month dietary intervention of a 30% reduction in total calorie consumption.
- Almost half of the participants had some form of chronic musculoskeletal pain; neck and back pain were most commonly reported (60%)
- Dietary intake, body weight, waist circumference, body fat and pain measures were assessed at baseline and after three months
- Diet quality was assessed using the Dietary Guideline Index (DGI), a food-based score ranging from 0 – 120 with higher scores suggesting closer adherence to 2013 Australian Dietary Guidelines (and therefore better diet quality)
- Pain measures were based on the presence of pain at a specific body site in the previous 24 hours. Chronic musculoskeletal pain was defined as pain at a specific body site lasting longer than three months.
- Pain-related quality of life was measured using the RAND Short Form-36 Health Survey bodily pain transformed scale (SF36-BPS) and any changes to severity or nature of pain were measured using the short form McGill Pain Questionnaire (MPQ)
- Participants daily energy intake ± standard error reduced from 9,120.9 ± 174.4 KJ/day to 5,821.6 ± 176.0 KJ/day. In general, the average person needs to consume around 8,700 KJ/day to maintain weight − however, this is dependent on several factors, e.g. age, sex, energy expenditure.
- After three months, the participant’s average weight change was -7.1 ± 0.3 kg (95% confidence interval [CI] = -7.7 − -6.4). Reductions in waist circumference (-7.1 ± 0.5 cm; 95% CI = -8.2 − -6.1) and body composition (-3.9 ± 0.2%; 95% CI = -4.4 − -3.5) were also observed.
- Overall diet quality significantly improved; the average total DGI score increased from 49.5 ± 1.7 at baseline to 75.5 ± 1.7 after three months; a 22% increase
- Notably, the DGI score for non-core foods, e.g. alcohol and unsaturated fats, increased by 44% (indicating lower intake)
- The number of participants reporting chronic musculoskeletal pain reduced from 50% (n = 52) to 24% (n = 25). SF36-BPS scores also increased by 6.9 ± 2.1 (95% CI = 2.7 – 11.1) indicating reduced pain levels
- Mediation analysis was performed to determine if the reduction in adiposity (the mediator) was the sole mechanism by which diet quality affects chronic musculoskeletal pain. The authors found that an improvement in diet quality may have a direct effect on pain severity when changes in body composition and waist circumference are accounted for, however, this intervention does not explain the improvements observed across all pain measures and adiposity reduction likely has a role in these processes.
- There are several limitations for this study:
- The original study was designed to examine whether almond consumption resulted in greater weight loss and limits weight re-gain compared with an energy-matched nut-free diet. Although data from the almond and nut-free groups were combined for this new analysis to focus on the overall effect of diet modification, the participants were not specifically recruited to examine chronic musculoskeletal pain as a primary outcome and may not match other chronic pain study populations.
- The small sample size and absence of a control group that improved their overall diet quality without reducing daily calorie intake decrease the reliability of these findings
- COVID-19 restrictions prevented in-person three month assessments for some participants and body composition and waist circumference measurements could not be recorded
- People with a BMI > 34.9 kg/m2 were excluded due to the limitations of DEXA in this study (to measure body fat composition)
Ward SJ, Coates AM, Carter S, et al. Exploring the role of diet quality and adiposity in the pain experience: a mediation analysis. Eur J Nutr 2025;64:266. doi:10.1007/s00394-025-03772-0.
This Bulletin is supported by the South Link Education Trust
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