Best Practice Bulletin: Issue 150

Published: 19^th June, 2026

Welcome to the 150^th edition of Best Practice Bulletin
Latest resources from bpac^nz
Rewind: Wrap-up of recent key messages
Medicine news: Colchicine, lansoprazole, rizatriptan, valaciclovir, benzathine benzylpenicillin, efavirenz + emtricitabine + tenofovir disoproxil
Upcoming changes to HPV vaccination schedule
Consultation for paramedic prescriber medicines lists + ambulance medicines funding change
Webinar on ACC Medical Certification Dashboard
June is Bowel Cancer Awareness Month
Cancer Control Agency: New look for cancer insights
Paper of the Week: Muscling in on muscle loss

Welcome to the 150^th edition of Best Practice Bulletin

Today marks a special milestone in the history of Best Practice Bulletin: the 150^th time we have announced our latest resources, reported on important news for primary care and delivered a curated selection of other items of interest.

Let’s take a look back through the archives to see what was news when this all first began

May, 2020
- 1^st Issue of Best Practice Bulletin published
- Previously called “The COVID-19 Bulletin”; eight editions were published under this banner
- In this Issue we reported that an extra-large number of influenza vaccinations had been obtained to meet high demand for “flu season” and spirometry requirements were being temporarily removed as a funding criterion for some inhalers as this increased the risk of exposure to COVID-19. We announced the launch of BPACRx prescribing software and our latest topic in our Primary Care Update series. Medicine supply issues were starting to become commonplace.
June, 2020
- First appearance of the now regular “Paper of the Week” segment in Issue 2 of the Bulletin: Is there a gene for thinness?
March, 2021
- First “Podcast of the Week” published in Issue 21 (although it wasn’t called that until Issue 35): clinicians speaking out about their own mental health struggles
December, 2021
- The first time we reported a “Year in review” and published a Christmas message and themed Paper of the Week - The holly and the ivy: a festive platter of plant hazards
May, 2022
- 50^th Issue of Best Practice Bulletin published
- In this Issue we profiled a new bpac^nz publication on low back pain, we noted the current “onslaught” of respiratory illness being managed by primary care, we reported a trial of a new preventative treatment for children at high risk of respiratory syncytial virus (palivizumab: now funded for select children) and updated on changes to COVID-19 vaccinations
May, 2024
- Celebrated the 100^th Issue of Best Practice Bulletin with the launch of three new publications from bpac^nz on pneumonia, assessing fever in young children and HIV pre- and post-exposure prophylaxis
- Other topical items included a concerning rise in pertussis, more COVID-19 vaccine updates, the usual medicine supply issues and launch of the Headstrong app to support mental health and wellbeing in rangatahi (young people)
August, 2024
- Introduced the Medical Factorium, our popular occasional segment where we answer questions about curious medical oddities such as why do we yawn; why do joints ache when it’s cold; why do songs get stuck in our head; why is gout called gout; and the case of the crimson nose
June, 2026
- Today we publish our 150^th Issue 🥳

We publish Best Practice Bulletin as a way to connect our audience with the most important bits of information from primary care. We try to keep it about the clinical news and education and steer clear of the political. As much as possible, we also like to make it an enjoyable read, something to look forward to on a Friday.

Thank you for joining us in our sesquicentennial (we like big words around here). We were going to end with “See you for our 200^th”, but actually, we would prefer to see you again for Issue 151, and the next one, and the one after that…

If you have ideas for topics for the Bulletin or any of our segments, email: editor@bpac.org.nz

Latest resources from bpac^nz

It has been a busy first half of the year for the bpac^nzpublications team, with many articles published on a range of topics, including urinary tract infections in children, reporting adverse reactions, chronic kidney disease, genital herpes, pharmacological management of ADHD and migraine. View our latest articles here. CPD activities, including clinical audits, peer group discussions and quizzes/case studies are also available.

Stay tuned for our upcoming articles on SGLT-2 inhibitors, and Beyond breathlessness: Diagnosis and management of patients with COPD

Rewind: Wrap-up of recent key messages

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

New HbA_1c diagnostic thresholds for diabetes and pre-diabetes come into effect from 1^st July to align with international standards. For further information, see Bulletin 144.
Stock of progesterone 100 mg capsules (Utrogestan) has arrived in the country, following a period of limited supply (as last reported in Bulletin 147). Monthly dispensing of Utrogestan has applied since May; Pharmac are working to return stat dispensing; a date is yet to be announced.

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.

Colchicine 500 microgram brand change

The funded brand of colchicine 500 microgram tablets, used for the treatment of gout, is changing from Colgout to Indoco. Indoco 500 microgram tablets will be listed on the Pharmaceutical Schedule from 1^st July. Colgout will be delisted on 30^th November. A brand switch fee will be available to pharmacists from 1^st December.

Advise patients taking colchicine that their brand will change between July and December, and that the packaging will look different: the medicine will now come in blister packs rather than a bottle as this may reduce the likelihood of colchicine overdose. Reassure patients that there has been no change to the active ingredient and the tablet appearance will be similar. Patients are recommended to talk to their pharmacist if they have dexterity problems with opening blister packs.

A patient information sheet about the brand change is available here

Supply issue affecting lansoprazole 30 mg capsules (Lanzol Relief)

There is a supply issue affecting lansoprazole 30 mg capsules (Lanzol Relief), a proton pump inhibitor, due to manufacturing issues. A re-supply date is unknown; the 15 mg presentation is not currently affected. An alternative brand (Lansoprazole Viatris; orodispersible tablet) has been funded since 12^th June;^* however, it is not approved by Medsafe, therefore will need to be prescribed for supply under Section 29A of the Medicines Act. This brand contains phenylalanine which will not be suitable for all patients. Pharmacists may be able to dispense 2 × 15 mg capsules of the Lanzol Relief brand for patients in whom Lansoprazole Viatris is not suitable or tolerated.

* The listing should appear automatically in dispensing software; it will not appear in the online Pharmaceutical Schedule until 1^st July. Pharmac advises that claims for Lansoprazole Viatris in June will be processed.

Rizatriptan 10 mg tablets supply issue

There is a supply issue affecting rizatriptan 10 mg tablets (Rizamelt), used for the treatment of acute migraine, due to manufacturing issues. Re-supply is expected in November. An alternative brand (Rizatriptan Rising) has been funded since 12^th June;^* however, it will not be available to order until later this month. Rizatriptan Rising is not approved by Medsafe, therefore will need to be prescribed for supply under Section 29A of the Medicines Act.

* The listing should appear automatically in dispensing software; it will not appear in the online Pharmaceutical Schedule until 1^st July. Pharmac advises that claims for Rizatriptan Rising in June will be processed.

Valaciclovir 1,000 mg tablets (Vaclovir) to go out of stock

Stock of valaciclovir 1,000 mg tablets (Vaclovir), used for shingles and herpes, are limited due to manufacturing delays. Re-supply is expected in July. Two alternative brands (Valaciclovir Mylan and Valaciclovir Viatris) have been listed on the Pharmaceutical Schedule, however, neither brand is approved by Medasfe, therefore will need to be prescribed for supply under Section 29A of the Medicines Act.

Pharmac is asking pharmacists to dispense either of these brands where possible, rather than 2 × 500 mg tablets to avoid a supply issue with the 500 mg strength. Pharmacists should also be aware that Valaciclovir Mylan and Viatris come in a pack size of 21 rather than 30 tablets (Vaclovir).

Supply issue affecting benzathine benzylpenicillin (Bicillin LA)

Benzathine benzylpenicillin (Bicillin LA) is expected to go out of stock later this year due to delays at the manufacturer. Re-supply is scheduled for November. This antibiotic is primarily used for the prevention of acute rheumatic fever and the treatment of syphilis. An alternative brand (Benzetacil)^* has been listed on the Pharmaceutical Schedule. It contains the same quantity of active ingredient; however, it comes in the form of a dry powder for reconstitution, rather than a pre-filled syringe. When reconstituted, the volume administered to patients is larger than Bicillin LA (4.8 mL compared to 2.3 mL).

Health New Zealand, Te Whatu Ora, is advising clinicians to prioritise stock of Bicillin LA to patients who need smaller injection volumes (e.g. younger children; view all priority groups here). Guidance on when to use Bicillin LA and Benzetacil for specific conditions is available here. Primary care clinicians are asked to prescribe oral alternatives to benzathine benzylpenicillin for patients with sore throats and skin infections due to Group A Streptococcus (where appropriate).

* Benzetacil is currently listed as Section 29 in the Pharmaceutical Schedule, however, it has received provisional Medsafe approval. The Schedule will be updated in the July release allowing Benzetacil to be supplied on standing order and PSO.

Ongoing supply issues affecting efavirenz + emtricitabine + tenofovir disoproxil

Supply issues affecting efavirenz with emtricitabine and tenofovir disoproxil (Viatris), used for HIV infection, have been ongoing for some time due to manufacturing delays. A re-supply date is unknown. Stock of the currently listed alternative brand (Teevir; Section 29) is expected to be exhausted this month. A temporary new brand, Tenofovir Efavirenz Emtricitabine (Mylan), has been available since 12^th June;^* however, it is not approved by Medsafe, therefore will need to be prescribed for supply under Section 29A of the Medicines Act.

* The listing should appear automatically in dispensing software; it will not appear in the online Pharmaceutical Schedule until 1^st July. Pharmac advises that claims for the Mylan brand in June will be processed.

Upcoming changes to HPV vaccination schedule

From Monday, 27^th July, HPV vaccination (Gardasil 9) provided through the School-Based Immunisation Programme will change to a one-dose course. Currently, the approved HPV vaccination course in New Zealand is two doses for children aged 9 – 14 years; therefore, a single-dose course will be off-label. However, evidence has demonstrated that a single HPV dose provides comparable protection to a two-dose course, with studies showing approximately 97 – 98% effectiveness against HPV infection and related cancers. This has led to many countries, including Australia, switching to a single-dose course in recent years.

A second dose can still be administered (funded) at least six months after the first in general practices or other community health providers if requested. Primary care is not expected to recall or actively follow-up children aged 9 – 14 years for a second dose. However, opportunistic catch-up vaccination (funded) should be offered to older children and adults aged up to 26 years who have not received any HPV doses.

IMAC and Health New Zealand are hosting an upcoming webinar on vaccinations to prevent cancer, covering HPV (including evidence for one dose) and hepatitis B. This free webinar is being held on Tuesday, 30^th June, from 5:00 pm. Click here to register.

Consultation for paramedic prescriber medicines lists + ambulance medicines funding change

The Ministry of Health, Manatū Hauora, is seeking feedback on a proposed specified prescription medicines list for designated paramedic prescribers. Earlier this month, the decision to enable some paramedics to become designated prescribers was announced. This followed a consultation that was conducted at the end of 2025 by the Paramedic Council of New Zealand to determine whether paramedics in New Zealand should be granted prescribing authority (as reported in Bulletin 138). Feedback from this consultation is available here.

The proposed list includes a range of medicines for:

Infections, e.g. amoxicillin, cefalexin, anti-infective ear and eye preparations containing framycetin or ciprofloxacin
Analgesia, e.g. naproxen, celecoxib, codeine, tramadol
Asthma, e.g. bronchodilators
Cardiovascular disease, e.g. beta blockers, calcium channel blockers, antiarrhythmic medicines, statins
Gout, e.g. allopurinol, colchicine, prednisone
Diabetes, e.g. metformin
Gastroesophageal reflux disease, e.g. omeprazole

View the full proposed list here

Extended Care Paramedics are increasingly being utilised in general practice clinics as part of the multidisciplinary team supporting patients with urgent, unscheduled community care needs. Proposed benefits of introducing paramedic prescribers include patients being able to access medicines and treatments in a timelier manner, the potential to reduce health inequities for certain groups, e.g. those who live rurally, and reducing the burden of work on other health care providers.

Consultation on the medicines list closes Sunday, 5^th July. Feedback can be submitted here.

Medicines on ambulances to be funded via Pharmac

In a separate news release, Pharmac has announced that from 1^st July, it will be responsible for funding medicines used in ambulances. Previously, ambulance providers would purchase medicines via funding from Health New Zealand and ACC. A series of changes will be made to the Pharmaceutical Schedule on 1^st July, including the addition of a new section (Section E), where all funded ambulance medicines will be listed. Read more here.

Also from 1^st July, tenecteplase, used for the treatment of ST-elevation myocardial infarction (STEMI), will be funded for emergency ambulance and PRIME services. This change is anticipated to reduce logistical barriers associated with obtaining the medicine; previously, tenecteplase was provided to PRIME and ambulance service providers from Health New Zealand hospitals.

Webinar on ACC Medical Certification Dashboard

Collaborative Aotearoa is hosting an upcoming webinar, presented by BPAC Clinical Solutions and ACC, on the ACC Medical Certification Dashboard. This interactive dashboard is offered through BPAC CareSuite, and provides information on your medical certification practice, including the ratio of ‘fully unfit’ and ‘fit for selected work’ certificates, average incapacity durations and return-to-work timeframes. This information can be used for self-reflection of practice and peer group discussion. The webinar is expected to cover how to access and use the Dashboard and how to interpret the data.

This free webinar will be held on Wednesday, 24^th June, from 12:00 pm. Click here to register.

June is Bowel Cancer Awareness Month

This month (June) is Bowel Cancer Awareness Month. New Zealand has one of the highest incidences of bowel cancer in the world; approximately 3,000 people are diagnosed with bowel cancer each year. It is also a leading cause of cancer mortality (after lung cancer) with more than 1,200 deaths per year.

People aged 58^* – 74 years (who are not already part of a high-risk surveillance bowel screening programme) are currently eligible for funded bowel cancer screening every two years using the faecal immunohistochemical test (FIT). The Government recently announced that the eligibility age is to be lowered again from the end of September, 2026, to 56 years for all people; the timeline for nationwide roll-out of this change has not yet been announced.

* Eligibility age in the MidCentral district is 60 – 74 years; this is reportedly being lowered to age 58 – 74 years in the coming months

Opportunistically check if eligible patients have received a bowel cancer 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: https://bpac.org.nz/2020/bowel-cancer.aspx

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: https://bpac.org.nz/2021/bowel-cancer.aspx and https://bpac.org.nz/2021/bowel-polyps.aspx

Cancer Control Agency: New look for cancer insights

In a recent email to the sector, Te Aho o Te Kahu, Cancer Control Agency, has announced the addition of a new section on their website: CanStats. CanStats features national and international cancer data and other resources on aspects of cancer control, including prevention, screening, diagnosis, treatment, survivorship as well as population insights. This replaces “Reports and numbers” and “Cancer in Numbers” sections of the website.

For example:

“Screening” includes links to the BreastScreen Aotearoa Coverage, National Bowel Screening Programme Participation and National Cervical Screening Programme Coverage data
“Diagnosis” includes links to the cancer data web tool (cancer registrations, diagnoses and deaths in New Zealand), cancer care data explorer (quality of life and outcomes of people with cancer in New Zealand) and the diagnostic dashboard (wait times for the past three years for diagnostic procedures that can be part of the cancer pathway)
“Population Insights” includes reports on disability and cancer, state of cancer and links to the New Zealand Health Survey and New Zealand population data

Paper of the Week: Muscling in on muscle loss

Maintaining muscle mass is crucial for healthy ageing and as the saying goes “use it or lose it”. Muscle loss typically begins after the age of 40 years with a more marked decline in people aged 60 years and over. This gradual reduction in muscle mass and impaired physical function can progress to a formal diagnosis of sarcopenia, which is associated with worse health outcomes in later life, e.g. increased risk of falls. Most older adults need to increase their physical activity, with a particular emphasis on maintaining and developing muscle mass; resistance training is now recommended as part of non-pharmacological management for many chronic conditions. It is also important to acknowledge that reduced muscle mass is not solely a concern for older adults. Younger patients with chronic conditions, reduced mobility or a history of malnutrition may be at risk of reduced muscles mass. The recent increased use of glucagon-like peptide-1 (GLP-1) receptor agonists has prompted warnings about the risk of muscle loss and advice to increase protein intake and resistance training. Despite the potential consequences, primary care clinicians currently have limited guidance on who to assess for muscle loss and how this should be carried out.

An article published in the Australian Journal of General Practice describes a practical approach to evaluating and monitoring muscle mass in older patients. Clinicians should be aware of the various risk factors for low muscle mass; patients with at least one risk factor should undergo further assessment, e.g. five-times sit-to-stand, three-metre timed-up-and-go, hand grip strength test. The results of this assessment determine whether a prevention (i.e. general advice about exercise and nutrition) or management approach (referral to nutrition and activity support) is appropriate. Identifying patients with lower muscle mass earlier allows intervention to reduce further muscle loss, and in some cases reverse muscle loss, improving quality of life.

Is lean muscle mass a primary concern for you when treating older patients with chronic conditions? Are patients generally aware of the relationship between muscle mass and healthy ageing? How confident do you feel with providing advice around physical activity, nutrition and maintaining/increasing muscle mass? What are some of the recommendations you give to patients?

Browse bulletin items by A-Z