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Published: 10th April, 2026
Contents
New from bpacnz - Management of genital herpes: reducing stigma
From a medical perspective, genital herpes is a straight-forward, easily treated condition for most patients. However, significant social stigma is often associated with a diagnosis. Effective management of genital herpes requires consideration of both medical and psychosocial implications. A common misconception is that an asymptomatic sexual partner does not have herpes simplex virus (HSV), often leading to the assumption that the symptomatic partner is “to blame”. However, this is not necessarily the case as many people with HSV do not develop symptoms (they can be asymptomatic “shedders”) or have the virus for months or even years before symptoms occur.
We present an overview of the management of patients with genital herpes, covering key clinical points from the 2024 New Zealand guidelines from the Sexually Transmitted Infections Education Foundation.
Read the article here. A B-QuiCK summary is also available.
In case you missed it: Latest publications from bpacnz
Chronic kidney disease: the canary in the coal mine
Chronic kidney disease (CKD) is a growing issue in New Zealand that disproportionately affects Māori and Pacific peoples. Early detection of CKD through regular testing of at-risk patients enables timely interventions to slow the rate of CKD progression and modify the associated increased risk of cardiovascular disease. The management of CKD has advanced in recent years and is achieved through lifestyle interventions and a combination of medicines targeting different aspects of the cardio-renal system; the “four pillars” approach.
Read the article here. A B-QuiCK summary is also available.
Upfront: Reporting adverse reactions – the easy way
Reporting suspected adverse reactions helps Medsafe and the Centre for Adverse Reactions Monitoring (CARM) monitor the safety of medicines and vaccines in New Zealand. An electronic reporting tool was developed several years ago by BPAC Clinical Solutions, to make reporting adverse reactions easier. Initially, there was good uptake of the tool; since the COVID-19 pandemic, however, reporting using the tool has decreased. This is a timely reminder about the importance of reporting adverse reactions, and the simple way you can do this.
Read the article here
Rewind: Wrap-up of recent key messages
Key dates and updates on news items from recent editions of Best Practice Bulletin:
- Giveaway reminder – it’s not too later to enter!
We are running a competition to give away three copies of “What Was I Thinking”, by Greg Judkins. Tell us about what it felt like to be on the receiving end of a formal complaint and what strategies you used to cope during the process (details of the complaint itself are not necessary; entrants/winners names will not be published). We have some great responses so far. Email your account, with the subject "Book Competition", by next Friday, 17th April to: editor@bpac.org.nz.
- Flu season has begun for 2026. Influvac Tetra (quadrivalent vaccine) is the sole funded influenza vaccine for children aged six months and over and adults who meet eligibility criteria. For further information on eligibility criteria, available vaccines, strains and dosing, see Bulletin 144.
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 4 mg tablets in limited supply
There is a supply issue affecting candesartan 4 mg tablets (Candestar) due to manufacturing delays. Other strengths of this angiotensin-II receptor blocker (ARB) are currently unaffected. An alternative brand has been listed on the Pharmaceutical Schedule (Candesartan Viatris Sante) since 1st April. Patients can be reassured that there has been no change to the active ingredient, however, the excipients, tablet appearance and packaging of the Candesartan Viatris Sante brand will be different to Candestar (French labelling and round tablets with dose imprinted).
An information sheet for patients about the supply issue is available here. A letter for healthcare professionals from Viatris with more details is available here.
Supply issue affecting progesterone 100 mg capsules (Utrogestan)
Supply of progesterone 100 mg capsules (Utrogestan) is limited due to high demand and manufacturing delays; this medicine is most often used as part of menopausal hormone therapy. The supplier, Pharmaco, is limiting supply to avoid an out of stock situation, therefore, pharmacies may receive a smaller quantity of stock than usual. Pharmacists may need to temporarily adjust dispensing quantities. New shipments are expected over the next one to two months.
Phenytoin out of stock possible in some regions
Supply of phenytoin 30 mg capsules (Dilantin), indicated for several types of seizures, is currently limited and pharmacies in some regions may run out of stock for a short period. This follows an equipment failure at the factory that led to shipping delays. The next shipment has been air-freighted to New Zealand and stock is expected to arrive at pharmacies from Monday, 13th April. Other strengths and formulations of phenytoin are not affected by this supply issue.
Conflict in the Middle East and potential supply issues
New cautionary and advisory label for some anti-seizure medicines
From 1st April, 2026, a new cautionary and advisory label (CAL) has been introduced for anti-seizure medicines that are at highest risk of causing fetal anticonvulsant syndrome if taken during pregnancy:
- CAL 19: Talk to your prescriber if you are pregnant, planning to become pregnant, or are breastfeeding
The purpose of CAL 19 is to raise awareness of the risk of fetal anticonvulsant syndrome in people of childbearing potential who are prescribed anti-seizure medicines for the management of conditions such as epilepsy, migraine and neuropathic pain, and to prompt them to discuss these risks with their prescriber or other healthcare professional.
Read more
Children exposed to certain anti-seizure medicines in utero can develop fetal anticonvulsant syndrome, which is characterised by features such as facial deformation, cleft palate, spina bifida, heart defects, developmental delays and behavioural difficulties. Eight anti-seizure medicines (below) have been identified as being associated with the highest risk, particularly if taken at high doses and in combination with other anti-seizure medicines.
CAL 19 should be applied to the following anti-seizure medicines at the time of dispensing, regardless of their indication:
- Carbamazepine
- Ethosuximide
- Oxcarbazepine
- Phenobarbitone
- Phenytoin
- Primidone
- Sodium valproate
- Topiramate
An information sheet for patients about anti-seizure medicines and pregnancy is available here.
NZF Practice highlight. In the April release, the NZF team also highlight the new CAL 19; click here for details.
Updated COVID-19 vaccine recommendations
Recommendations for who should receive additional doses of the COVID-19 vaccine have been updated in the latest version of the Immunisation Handbook, resulting in changes for some groups. However, eligibility for funded vaccination remains the same, i.e. one additional dose is funded every six months for previously vaccinated people aged ≥ 30 years, or every six or 12 months for people aged ≥ 6 months who are immunocompromised or at high risk of severe illness.
What this means is that there is now more specific clinical advice about patients who are most likely to benefit from additional doses of COVID-19 vaccine, and at what frequency. However, clinical discretion still applies and if it is considered that a patient would benefit from ongoing COVID-19 vaccination, this will still be funded for them if they are aged ≥ 30 years.
Read more
| Six monthly COVID-19 vaccination recommended (highest risk groups) |
Annual COVID-19 vaccination recommended (high risk groups) |
- People aged ≥ 75 years
- People aged ≥ 65 years living in aged residential care facilities
- People aged ≥ 50 years with pronounced frailty/multiple co-morbidities, based on clinical discretion
- People with severe immunocompromise
|
- People aged 65 – 74 years
- People aged 50 – 74 years of Māori or Pacific ethnicity
- People aged 16 – 64 years living in aged or disability residential care facilities
- People aged ≥ 5 years with at least one co-morbidity that increases risk of severe COVID-19
|
N.B. This is not an exhaustive list.
People aged 30 – 64 years who do not meet any of the criteria in the table above are now considered to be at lower risk of severe infection, and additional doses are no longer routinely recommended. Exceptions to this would be people who are a frontline healthcare, aged-care or disability worker or other carer, in which case annual COVID-19 vaccination is still recommended.
A factsheet is available from IMAC here.
Pharmac consultation on possible medicine brand changes
Pharmac is seeking feedback on a consultation about brand changes for a wide range of medicines that may occur this year as a result of the annual tender process. The annual tender process secures pricing and supply for many medicines in New Zealand. Medicines with possible brand changes this year include colecalciferol, amitriptyline, aripiprazole, atomoxetine, escitalopram, risperidone, cetirizine, tramadol, allopurinol, losartan, metoprolol succinate and aspirin (view all possible medicines affected here).
Read more
For each medicine, feedback is being sought on the following areas regarding if a brand change was to occur:
- What key issues should be considered by Pharmac?
- If there is currently more than one funded brand available, what impact could switching to a single funded brand have?
- What resources or support would be needed for healthcare professionals or patients?
- Are there specific aspects that should be considered for healthcare professionals when prescribing, dispensing or administering (e.g. pack sizes, packaging types, storage), or for patients (e.g. tablet size, taste, device design)?
- Are there any particular groups who would find changing brands challenging?
Consultation closes Monday, 4th May. Options to submit feedback are available here.
Register your practice for an upcoming bowel screening promotion
General practices are invited to participate in a National Bowel Screening Programme primary care promotion in May, to increase bowel screening in those who are under-screened. People aged 58 – 74 years are currently eligible for funded bowel cancer screening every two years using the faecal immunohistochemical test (FIT). Clinicians are encouraged to take any relevant opportunity to have a conversation about bowel screening with eligible patients, particularly those who are not participating in regular screening.
To participate in the campaign and get access to free resources, click here.
NZF updates for April
Significant changes to the NZF in the April, 2026, release include:
- Updated indications and dosing regimens for azithromycin and doxycycline to align with Te Whata Kura – National Antibiotic Guidelines. Indications and dosing regimens for nitrofurantoin, cefalexin and trimethoprim have also been updated for acute cystitis and prophylaxis of recurrent cystitis. Cefalexin dosing for uncomplicated pyelonephritis has also been updated.
- Terminology updated in the contraception and conception section for isotretinoin (systemic)
- Updates to the following sections in the gabapentin and pregabalin monographs: cautions, pre-treatment screening, monitoring, adverse effects, dosing regimen and patient advice
- Section in the therapeutic notes for cautionary and advisory labels updated to include information on the new CAL 19 label applied to anti-seizure medicines: Talk to your prescriber if you are pregnant, planning to become pregnant, or are breastfeeding
- New monograph added for cinchocaine + prednisolone hexanoate (Section 29, unapproved medicine), indicated for haemorrhoids, pruritus ani, superficial anal fissures and proctitis. This medicine has become available because of stock issues affecting Proctosedyl and Ultraproct suppositories, as reported in Bulletin 144.
- New monograph added for vanzacaftor + tezacaftor + deutivacaftor (Alyftrek), indicated for people with cystic fibrosis who have specific mutations (this medicine has been funded with Special Authority approval since 1st April; as reported in Bulletin 143)
- Updated indications and dosing regimens for aripiprazole depot injection
You can read about all the changes in the April release, here. Also read about any significant changes to the NZF for Children (NZFC), here.
Paper of the Week: Two sprays to keep the patient away
Winter is coming and with it, the inevitable increase in demand on primary care services, predominantly driven by more patients presenting with respiratory tract infection symptoms. Patient demand for antibiotics in this situation raises further issues around inappropriate prescribing and antimicrobial resistance. There will always be patient groups in whom medical assessment is appropriate, but ideally, most otherwise healthy people with coughs and colds can (and should) manage at home with self-care, e.g. rest, fluids and over-the-counter paracetamol or decongestants. Are there any other preventative options that prescribers and community pharmacists can suggest to patients to reduce the impact of respiratory tract infections, and potentially the need to present to primary care in the first place?
A study published in the British Journal of General Practice investigated if nasal sprays or a website promoting physical activity and stress management were effective preventative interventions for respiratory tract infections, compared to usual care (i.e. standard management advice) over a 12-month period. Use of either a gel-based polymer nasal spray that lowers pH or isotonic saline nasal spray at the first sign of illness, or following an exposure event, reduced the number of respiratory illness days compared to usual care. However, only the saline nasal spray reduced the number of medical centre visits for respiratory tract infections and courses of antibiotics prescribed during the study period (antibiotic result not significant). These findings alongside the low risk of adverse effects and cost (compared to a primary care consultation) support the use of over-the-counter nasal sprays, particularly saline-containing products, to reduce the overall impact of respiratory tract infections on patients and potentially the primary care system.
Do you routinely prescribe or recommend nasal sprays for patients with symptoms of a respiratory tract infection? What other interventions do you recommend patients trial to reduce the likelihood of respiratory tract infections, e.g. supplements, lifestyle interventions? How effective do patients find these?
Read more
- This four-arm randomised controlled trial was conducted in primary care practices in the United Kingdom between December, 2020, and April, 2023
- Participants were included if they had at least one risk factor or co-morbidity, e.g. heart disease, diabetes, asthma, and/or reported ≥ 3 respiratory tract infections in the previous 12 months
- Approximately 14,000 participants (55% female, median age 64 years) were randomised to receive either:
- Usual care, i.e. standard management advice (n = 3,449)
- Gel-based nasal spray that contains polymer and buffers to lower pH - Vicks First Defence; available in New Zealand (n = 3,447)
- Isotonic saline nasal spray - Sterinase; not available in New Zealand but many similar options are available, select one with 0.9% sodium chloride (n = 3,449)
- Access to a behavioural website promoting general physical activity and stress management developed by the study authors (n = 3,445)
- Participants in both nasal spray groups were advised to use the spray up to six times daily at the first sign of an illness developing, after potential exposure to an infection, e.g. visiting a supermarket, or after prolonged exposure, e.g. unwell household member. N.B. Be aware that some nasal sprays contain ingredients that are not suitable for prolonged use due to the risk of rebound congestion, such as xylometazoline.
- The primary outcome was days of illness from self-reported respiratory tract infections. Secondary outcomes included days where symptoms experienced were moderately bad or worse, days where work or normal activities were impaired, healthcare service contact, antibiotic use and mental health.
- Participants completed questionnaires every 28 days to measure outcomes during the study period, as well as at six and 12 months to recall respiratory infections
- Participants receiving usual care experienced on average 21.8 days of illness (standard deviation [SD] = 35.2 days), compared to 17.8 days (SD = 27.9 days) in the Vicks First Defence nasal spray group and 17.7 days (SD = 21.1 days) for those in the saline nasal spray group
- This equates to an adjusted incidence rate ratio (IRR) of 0.84 (99% confidence interval [CI] = 0.79 – 0.90) for Vicks First Defence nasal spray and 0.83 (99% CI = 0.78 – 0.89) for saline nasal spray
- Participants randomised to the website group reported an average of 19.5 days of illness (SD = 31.2 days), however, this result was not significantly different from usual care (IRR = 0.94; 99% CI = 0.88 – 1.01)
- All three interventions significantly reduced the number of days with moderately bad or worse symptoms (i.e. disease severity) and number of days where work or normal activities were impaired
- Fewer times seeking medical attention for respiratory tract infections and antibiotic courses in the past 12 months were only reported for participants in the saline nasal spray group, however, the antibiotic finding was not significant (IRR = 0.84; 95% CI = 0.71 – 1.00)
- Participants in the saline nasal spray group were less likely to experience headaches compared with usual care, while those in the Vicks First Defence nasal spray group were more likely to experience headaches. Both nasal spray interventions reduced nasal dryness/irritation, and notably, falls (possibly due to fewer respiratory infections, therefore less effect on balance).
- Potential study limitations include deviation from the original method and intervention adherence
- The primary outcome was intended to be based on respiratory infection recall data from six- and 12-month questionnaires, however, data from monthly questionnaires had to be used as some patients misinterpreted questions about number of infections since the beginning of the study in the 12-month questionnaire
- Nasal sprays were supplied by the study authors at randomisation and then on participant request and it is acknowledged that adherence to the advised dosing regimens was limited, especially for prevention. The findings of this study may therefore be an underestimate of the true effect of nasal sprays on respiratory tract infections.
Little P, Vennik J, Rumsby K, et al. Nasal sprays and a behavioural intervention for respiratory tract infections in primary care: 12-month follow-up of a randomised open-label trial. Br J Gen Pract 2025;:BJGP.2025.0269. doi:10.3399/BJGP.2025.0269.
This Bulletin is supported by the South Link Education Trust
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