Best Practice Bulletin: Issue 140

Published: 30^th January, 2026

Psychostimulant medicine prescribing for ADHD in primary care
Extended prescription lengths coming into effect
Rewind: Wrap-up of recent key messages
Nurse practitioners and pharmacist prescribers now able to prescribe Section 29 medicines
Medicine news: Nifedipine, mometasone furoate
Proposal to widen access and fund new medicines for cystic fibrosis
Monitoring Communications: GLP-1 receptor agonists and vision loss, atomoxetine and gynaecomastia
Authorised vaccinators no longer require standing orders to administer adrenaline or paracetamol
Amendments to roadside drug driving testing
NZF updates for January
Upcoming Goodfellow Unit webinars
Paper of the Week: Sun safety – Brighten up your knowledge on sunscreens

Psychostimulant medicine prescribing for ADHD in primary care

A wider range of healthcare professionals can prescribe psychostimulant medicines to adults with ADHD without recommendation from a specialist from next week (1^st February, 2026). This follows the decision by Pharmac and Medsafe to amend psychostimulant medicine prescribing and funding rules (as reported in Bulletin 126).

From 1^st February, 2026:

Vocationally registered general practitioners and nurse practitioners working in their area of practice can initiate psychostimulant medicines for patients aged 18 years and over with ADHD
Nurse practitioners working within their area of practice of paediatric services or child and adolescent mental health services can initiate psychostimulant medicines for patients aged 17 years and under with ADHD
Medical practitioners and nurse practitioners can continue psychostimulant medicines for any patient with ADHD if they have written approval from an authorised prescriber, i.e. paediatrician, psychiatrist or one of the prescribers mentioned above

The Special Authority criteria for methylphenidate, dexamfetamine and lisdexamfetamine have also been updated to allow application from any relevant practitioner, i.e. a health practitioner authorised to prescribe psychostimulant treatment for ADHD (as listed above).

To support prescribers, bpac^nz has prepared a brief “early access” resource to outline these changes and what they mean for primary care, click here.

Coming soon: Pharmacological management of ADHD in adults and children: a new frontier for primary care. A comprehensive article about prescribing psychostimulant medicines for patients with ADHD is currently in development by bpac^nz and will include information about pharmacokinetics, pre-treatment considerations and investigations, initiation and dose titration, monitoring, switching between formulation types and treatment cessation. N.B. This article will not cover the diagnosis of ADHD or the use of psychostimulant medicines for other indications such as narcolepsy.

Upcoming ADHD webinars for primary care

The Goodfellow Unit is hosting a free access webinar: Adult ADHD: From diagnosis to long-term management, presented by Consultant Psychiatrist Dr David Codyre. This webinar will cover aspects of a comprehensive management plan, medicines optimisation, monitoring response, managing common adverse effects and troubleshooting breakthrough symptoms. Treatment escalation will also be discussed. It is being held on Tuesday, 3^rd February from 7:30 pm. Click here to register. Webinars are often recorded and available to watch at a later date.

HealthPathways in conjunction with the RNZCGP is hosting an upcoming webinar on ADHD in adults: What’s changing - your role, your options, your support. Consultant Psychiatrist Dr David Codryre, Dr Prabani Wood and Dr Justine Lancaster will be presenting a free webinar covering topics including the new prescribing rules and boundaries, the Clinical Principles Framework, practical steps for screening and referral, managing ongoing care (including titration and supply issues), training options, HealthPathways updates and what to do if you choose not to provide comprehensive ADHD diagnostic care. The webinar will be held on Tuesday, 17^th February from 7 pm – 8 pm. Click here to register (a certificate of attendance and CPD points are available). A recording will be available at a later date.

Other resources to support primary care prescribers

Changes to the Rules for Prescribing Medicines for ADHD – Ministry of Health information sheet (2025)
Local HealthPathways
New Zealand Clinical Principles Framework for Attention Deficit Hyperactivity Disorder (2025)
Adult ADHD GP Masterclass (2025). Series of six webinars presented by Dr Sidhesh Phaldessai, a senior psychiatrist with a special interest in adult ADHD, in conjunction with the Royal New Zealand College of General Practitioners. The first webinar is free to access for all general practitioners. The rest of the webinar series is free for College registrars enrolled from February, 2022. There is a cost of $60 + GST for the remainder of the series for everyone else.
Goodfellow Unit. Webinars and e-learning resources. Both free and paid resources are available.
Safe, comprehensive, and equitable ADHD care (2025). The Royal Australian and New Zealand College of Psychiatrists Position Statement on ADHD care.

Extended prescription lengths coming into effect

From 1^st February, 2026, the period of supply limit for medicines will increase from three months to up to 12 months (as a result of amendments to the Medicines Regulations 1984). Changes to the Pharmaceutical Schedule will also be implemented to support increased prescription lengths. The maximum quantity of medicine supplied on each prescription will continue to be determined by the prescriber on a case-by-case basis, depending on individual patient circumstances; a 12-month prescription will not be clinically appropriate and safe for all patients. The maximum quantity of a medicine that can be dispensed at once will remain as it is now, i.e. up to three months (six months for oral contraceptives).

Information for prescribers and pharmacists

A position statement from the Royal New Zealand College of General Practitioners (RNZCGP) outlines that clinicians are expected to use clinical judgement when making prescribing decisions, and this should include a risk/benefit assessment for each patient. The College recommends that practices adopt their own in-house policy to guide their clinicians, always consider equity and access when deciding on a prescribing period and to work collaboratively with pharmacists.

The first dispensing must occur within three months of the prescription being issued; this is both a legal and funding requirement. Repeats on all prescriptions (including for quantities less than 12 months) may be dispensed up until 12 months after the prescription was issued. The prescription co-payment will continue to be charged once per prescription item, i.e. at the first dispensing.

Upcoming Pharmaceutical Schedule changes

The following changes to the Pharmaceutical Schedule will be made from 1^st February, 2026 (as reported in Bulletin 134):

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 lengths 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

View all the upcoming changes to the Pharmaceutical Schedule and the products they apply to here.

Some Special Authority renewal requirements were removed from specific medicines and medical devices in December, 2025, to align with these upcoming changes (see Bulletin 134 for details).

Guidance for prescribers and pharmacists, developed by Te Whatu Ora, is available here. A factsheet for patients is available from the Ministry of Health.

A poster and FAQ sheet for patients is also available from the RNZCGP to help explain the changes.

Rewind: Wrap-up of recent key messages

Key dates and news items from recent editions of Best Practice Bulletin:

The transition to the updated COVID-19 vaccine (Comirnaty LP.8.1; as reported in Bulletin 137) has begun for the 10 microgram presentation, indicated for use in children aged 5 – 11 years; stock of the Comirnaty JN.1 10 microgram vaccine has now expired. Transition to the 3 microgram (for eligible infants aged six months to four years) and 30 microgram (for people aged 12 years and over) Comirnaty LP.8.1 vaccines is expected to occur in February/March; JN.1 vaccines should continue to be used for these groups in the meantime. Updated factsheets are available from IMAC.
From 1^st February, 2026, eligibility criteria for the 3 microgram and 10 microgram COVID-19 vaccine will be widened (as reported in Bulletin 131), so that children aged under 12 years who are severely immunocompromised or at high risk of severe illness are eligible to receive an additional dose every six or 12 months. View full COVID-19 vaccine eligibility criteria here.

Nurse practitioners and pharmacist prescribers now able to prescribe Section 29 medicines

Amendments to the Medicines Act 1981 regarding Section 29 were made in November, 2025, enabling nurse practitioners and pharmacist prescribers to prescribe unapproved medicines, alongside medical practitioners. Section 29A and Section 29B were also introduced. Section 29A allows the prescribing of an unapproved medicine where it is funded by Pharmac as an alternative to an approved funded medicine that is affected by supply issues. Section 29B applies to the reporting of the sale or supply of a medicine under Section 29 or Section 29A to the Director-General of Health (or Medsafe). These changes will streamline the prescribing process when a medicine is affected by supply issues, and will reduce administrative burden for those not previously authorised to prescribe unapproved medicines. Requirements for clinicians to inform patients they are being prescribed an unapproved medicine remain.

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.

Nifedipine long-acting 20 mg tablets: limited stock

There is a supply issue affecting stock of nifedipine long-acting 20 mg tablets (Nyefax Retard), used primarily for hypertension and angina prophylaxis. The 30 mg and 60 mg strengths of nifedipine are not currently affected; 10 mg tablets are being discontinued (as reported in Bulletin 78). A re-supply date has not yet been announced.

An alternative product (Valni Retard S29) is being listed on the Pharmaceutical Schedule from 1^st February, 2026, and is expected to be available to order from the supplier by mid-February. However, it is not Medsafe approved and so must be prescribed for supply under Section 29A of the Medicines Act.

Mometasone furoate (Elocon): 15 g ointment, 50 g cream out of stock

The supplier is now out of stock of mometasone furoate (Elocon) 15 g ointment and 50 g cream, used for severe inflammatory skin disorders and seborrhoeic dermatitis, due to a previous supply issue affecting the 50 g ointment (as reported in Bulletin 138). The 50 g ointment is now available; other funded presentations currently available are the 15 g cream and 30 mL lotion. Patients may require a new prescription with a different pack size or presentation if they cannot collect their repeat.

Proposal to widen access and fund new medicines for cystic fibrosis

Pharmac is seeking feedback on a proposal to widen access to elexacaftor with tezacaftor and ivacaftor (Trikafta) and ivacaftor (Kalydeco), and fund vanzacaftor with tezacaftor and deutivacaftor (Alyftrek) for eligible people with cystic fibrosis.

It is proposed that from 1^st April, 2026:

Special Authority criteria for Trikafta would be amended to include all people with cystic fibrosis who have an eligible mutation (currently patients have to be aged six years or over); two new presentations would also be listed on the Pharmaceutical Schedule
Special Authority criteria for Kalydeco would be amended to widen access for people with cystic fibrosis with eligible mutations known to be responsive to Kalydeco. Application could be made by any relevant practitioner (currently initial application is restricted to a respiratory specialist or paediatrician). Two new presentations would also be listed on the Pharmaceutical Schedule.
Alyftrek would be funded with Special Authority approval for all people with cystic fibrosis with eligible mutations. Application could be made by any relevant practitioner.

Consultation closes Wednesday, 11^th February. This link contains an online form to complete.

Monitoring Communications: GLP-1 receptor agonists and vision loss, atomoxetine and gynaecomastia

Medsafe has issued a Monitoring Communication to seek more information from clinicians on the risk of acute onset persistent loss of vision with GLP-1 receptor agonists, e.g. dulaglutide, liraglutide, semaglutide. This safety communication has been made following two reports to the New Zealand Pharmacovigilance Database of sudden vision loss with semaglutide. Responses can be submitted until 26^th July, 2026, at which time the risk will be assessed; any adverse effect reports should continue to be submitted after this date.

A separate Monitoring Communication has also been issued on the risk of gynaecomastia in people taking atomoxetine. This follows a report of a 36-year-old male who developed bilateral gynaecomastia following a dose increase of atomoxetine. Responses can be submitted until 15^th June, 2026, at which time the risk will be assessed; any adverse effect reports should continue to be submitted after this date.

Healthcare professionals should be alert for these potential risks with GLP-1 receptor agonists and atomoxetine and report any suspected cases of vision loss or gynaecomastia to CARM.

Authorised vaccinators no longer require standing orders to administer adrenaline or paracetamol

Authorised vaccinators can now administer adrenaline and liquid paracetamol associated with immunisations without needing a standing order or prescription, following an amendment to the Medicines Regulations 1984 (Regulation 44A) on 19^th December, 2025.

Adrenaline 1:1000 ampoule is approved for inclusion in all “approved immunisation programmes” for anaphylaxis post-vaccination. Liquid paracetamol is approved for inclusion in the National Immunisation Programme when administering the Bexsero vaccine for children aged two months to 24 months. Authorised vaccinators may administer a prophylactic weight-based dose of paracetamol at the time of, up to 30 minutes before, or immediately after Bexsero vaccination. They can also supply additional doses for the parent/caregiver to administer at home. Further information is available from the Immunisation Handbook, here.

Amendments to roadside drug driving testing

In 2023, the Land Transport (Drug Driving) Amendment Act (LTAA) 2022 came into effect, listing 25 prescription medicines and illicit drugs (defined in the Act as Schedule 5) with highest risk for impairing driving. The Act also lists blood concentration levels for Schedule 5 substances that indicate impairment for offences related to drug driving.

Recent amendments, Land Transport (Drug Driving) Amendment Act 2025, enable New Zealand Police to perform random roadside drug driving testing (tongue swipe) for THC, methamphetamine, MDMA and cocaine. If there is a positive result for any of these four drugs, a second roadside screening test will be performed; two positive roadside drug screening tests will result in the person being prohibited from driving for 12 hours.

If a driver has a positive roadside drug screening test (even if the second test is negative), a saliva sample will be taken from them and sent for laboratory testing. This sample will be tested for all 25 prescription medicines and illicit drugs included in Schedule 5, i.e. not just the four included in the roadside drug screen. If this test is positive for any of the substances, an infringement notice will be issued to the driver.

If a prescription medicine from Schedule 5 is identified in the saliva sample, a medical defence is available to the driver post-incident (not roadside) if they have a valid prescription for that medicine and were taking it as prescribed.

Medsafe advice for healthcare professionals

Medsafe advise healthcare professionals to:

Be aware of the 21 prescription medicines listed in Schedule 5
- Benzodiazepines (and benzodiazepine-like medicines): alprazolam, clonazepam, diazepam, lorazepam, midazolam, nitrazepam, oxazepam, temazepam, triazolam and zopiclone
- Opioids: buprenorphine, codeine, dihydrocodeine, fentanyl, methadone, morphine, oxycodone and tramadol
- Other: amphetamine, THC, ketamine
Ideally check section 4.7 of medicine data sheets (and NZF cautions) when prescribing any medicine to determine the effect on driving
Discuss with patients and document in their notes if any prescription medicines they take could impair driving (also consider over-the-counter and pharmacist-only medicines)
Ask patients whether they have any symptoms when taking their medicine(s) that could impair driving, and therefore if they should be advised not to drive

For other practical tips for prescribers, see Bulletin 122.

NZF updates for January

Significant changes to the NZF in the January, 2026, release include:

Information about the drug action of methylphenidate hydrochloride has been added to its monograph. The following sections have also been updated: contraindications, cautions, pre-treatment screening, monitoring, dose regimen, adverse effects and patient advice.
Bacterial vaginosis:
- New guidance section on bacterial vaginosis added
- New monograph added on metronidazole (vaginal); Section 29, unapproved medicine, for bacterial vaginosis and recurrent bacterial vaginosis
- Recurrent bacterial vaginosis added as an indication (unapproved) for metronidazole (systemic)
Updated dose regimen for COVID-19 vaccine (mRNA-CV)
New guidance on deprescribing added to the therapeutic notes for proton pump inhibitors
New indication added for ticagrelor (unapproved indication): prevention of atherothrombotic events following acute minor stroke, high-risk transient ischaemic attack, or crescendo TIA
- Therapeutic notes for ischaemic stroke have also been updated to include ticagrelor as an option for initial management in some cases
Information in the drugs and driving therapeutic notes updated to include the 2025 amendment to legislation about medicines that can impair driving (see above item)
Links to the NZ Standardised batch sheets added to extemporaneous preparations. The section has also been updated.

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

Upcoming Goodfellow Unit webinars

The Goodfellow Unit, University of Auckland, is hosting several free access webinars in February. These webinars are intended to provide topical and relevant health information for primary care clinicians. Continuing professional development (CPD) points are also available. Webinars are often recorded and available to watch at a later date. Upcoming webinars include:

Adult ADHD: From diagnosis to long-term management, presented by Consultant Psychiatrist David Codyre. This webinar will be held on Tuesday, 3^rd February, from 7:30 pm. Click here to register.
Ovarian cancer: diagnosis to treatment, presented by Gynae-Oncologist Cecile Bergzoll. This webinar will be held on Tuesday, 10^th February, from 7:30 pm. Click here to register.
PCOS insights, and Pessary skills, Te Whatu Ora; Te Tiri Whakāro: Sharing Knowledge session. Obstetrician, Gynaecologist and Fertility Specialist Elizabeth Glanville will cover PCOS and Gynaecologist Niki Dykes will cover pessary skills. Dr Sue Tutty will also provide general updates at the end of the session. This webinar will be held on Tuesday, 24^th February, from 7:30 pm. Click here to register.

Paper of the Week: Sun safety – Brighten up your knowledge on sunscreens

It might not feel like it, but New Zealand is technically at the height of summer. This usually means beach trips, outdoor activities and increased sun exposure. However, as we know, prolonged exposure to sunlight (i.e. ultraviolet radiation [UV]) is associated with an increased risk of melanoma and non-melanoma skin cancers, exacerbation of other dermatological conditions and photo-ageing. Sun protection strategies, such as applying sunscreen, wearing a hat and sunglasses and seeking shade during the hottest period of the day reduce the risk of these outcomes. Recent social media trends involving unsafe sun behaviour, and a spotlight on the reliability of some SPF products, have highlighted the need for a focus on patient education. Primary care clinicians, particularly community pharmacists, are ideally placed to provide this information.

An article published in the Australian Journal of General Practice serves as a timely reminder for all healthcare professionals about the importance of sun protection and provides a summary of points that can inform patient discussions regarding sunscreens. Considerations when recommending the most appropriate sunscreen include intended use, history of sensitive skin and desired feel of the product; the best sunscreen is the one that the patient will be most compliant with applying. Sunscreen is often underapplied; the sun protection claims on sunscreen labels are valid only when the product is used in sufficient quantities on the skin. The importance of applying adequate amounts of sunscreen should be a key discussion point.

Does sun protection form a regular component of your patient discussions? How would you explain the terms “broad spectrum” and “SPF” to patients? Do you feel confident recommending specific products to patients? Do you know much sunscreen patients should be applying to their skin, and how often they need to reapply it?

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