From 1^st November, 2026, the currently funded brand of naltrexone 50 mg tablets, an opioid receptor antagonist used in opioid and alcohol dependence, is changing from Naltraccord to Naltrexone Lupin. Pharmac has announced that remaining supply of the Naltraccord brand is limited, and it may go out of stock prior to the new brand being funded and available in November. A temporary alternative brand, Naltrexone-GH, will be listed on the Pharmaceutical Schedule from 1^st September, 2026, to ensure continued access to this medicine until Naltrexone Lupin becomes available. However, Naltrexone-GH is not approved by Medsafe, therefore, will need to be prescribed for supply under Section 29A of the Medicines Act.

A patient information sheet is available here

A supply issue is affecting all strengths of the Zypine brand of olanzapine tablets (2.5 mg, 5 mg and 10 mg), an antipsychotic, due to manufacturing issues. Re-supply is currently expected by the end of the year. An alternative brand (APO-Olanzapine) will be listed on the Pharmaceutical Schedule from 1^st September, but stock will not be available to order until October. APO-Olanzapine is not approved by Medsafe, therefore, will need to be prescribed for supply under Section 29A of the Medicines Act. Reassure patients that there has been no change to the active ingredient, but the colour of the tablets and markings etched on them will be different.

There is a new supply issue affecting stock of Proctosedyl (hydrocortisone with cinchocaine) suppositories due to an issue during transit. Stock of Proctosedyl ointment is currently unaffected. Supply issues affecting stock of Ultraproct (fluocortolone caproate with fluocortolone pivalate and cinchocaine) suppositories and ointment remain ongoing. Proctosedyl and Ultraproct are used for haemorrhoids, anal pruritus, anal fissures, perianal eczema, pre- and post-haemorrhoidectomy and for non-infective proctitis.

An alternative suppository (Scheriproct; prednisolone hexanoate with cinchocaine hydrochloride) is available; a new prescription will be required. This product has different ingredients than Proctosedyl and Ultraproct and is not registered by Medsafe, therefore, needs to be prescribed for supply under Section 29A of the Medicines Act 1981.

The Royal New Zealand College of General Practitioners has issued guidance to practices, in particular around phone triaging patients with respiratory symptoms and the use of red/green streaming, where possible. Practices should also ensure adequate ventilation and maintain sufficient stock of PPE, such as masks and gloves.

The College has also released a media statement, encouraging people to stay at home if they are sick and to follow standard infection prevention control measures, e.g. handwashing, cover coughs and sneezes.

It’s not too late to vaccinate! Encourage influenza vaccination opportunistically and ensure patients who meet eligibility criteria for funded vaccination are aware that they can receive a flu vaccine for free. For further information, including a summary of available vaccines and eligibility criteria, click here.

Influenza vaccination rates remain lower so far this year, compared to 2025. As of 23^rd August, 58% of adults aged 65 years and over have received influenza vaccination, below the target of ≥ 75% and uptake in 2025 (60%). Vaccination rates for Māori (48%), Pacific (48%) and Asian peoples (49%) aged 65 years or over are also marginally lower compared to last year and lower than the overall target.

A second influenza dose is not necessary for most people. In an email to the sector this week, the Immunisation Advisory Centre says that current evidence does not support routine administration of a second influenza vaccine during the same influenza season, even for older or immunocompromised people. It may increase antibody levels, but there is a lack of evidence that this results in a clinical benefit. There are some exceptions where two doses of influenza vaccine are recommended, including for children aged under four years and immunocompromised people who have not been vaccinated before and people who have received a solid organ or stem cell transplant. A second dose could be considered in pregnant women who were vaccinated more than five months ago, prior to becoming pregnant.

Patient information sheets. Did you know that bpac^nz has patient information sheets on a range of topics, including information for managing seasonal viral illness (“Cold & Flu”). View all patient information sheets here.

• Monthly blood monitoring will no longer be mandatory for some patients who have been taking clozapine continuously for at least two years if they meet certain criteria. The risk of severe neutropenia is highest in the early stages of treatment and low after two years.
  • Patients will still need to self-monitor for symptoms and signs of infection and seek medical attention as needed
• Updated blood monitoring thresholds. The absolute neutrophil count thresholds for each colour of the “traffic light” system will be reduced and different thresholds for people with benign ethnic neutropenia will be specified. Monitoring of white blood cells will no longer be required and dispensing of clozapine will not be dependent on normal white blood cell results. Absolute neutrophil count is a more clinically relevant parameter to measure, and this approach aligns with European guidelines.
• Updated management of low neutrophils. Management of “red” absolute neutrophil count results will involve clinical review with repeat blood monitoring to confirm and determine the cause of the result, instead of immediate cessation of treatment (if clinically appropriate). Factors to consider when deciding if clozapine treatment can continue will also be updated.
• Prescribing restrictions for the continued prescription of clozapine would be extended to include nurse practitioners, nurse prescribers and pharmacist prescribers if it is within their scope of practice. Clozapine will still need to be initiated by a psychiatrist or a medical practitioner in consultation with a psychiatrist or working in a mental health team.

Read the full consultation outcome from Medsafe, here

• Results were obtained from the retrospective cohort of the Advancing knowledge in ischemic Stroke PatiEnts on oRal Anticoagulants (ASPERA) study, consisting of patients from 35 stroke centres across nine countries in Europe and North Africa
• The study population included adults with AF who experienced a breakthrough ischaemic stroke between February, 2020, and February, 2025, while taking oral anticoagulants (either direct oral anticoagulants [DOACs] or vitamin K antagonists); this was termed the “index event”
  • 1,649 patients were included; 52% were female and 79% were Caucasian, with a median age of 80.4 years
  • When the index event occurred, 77% of participants were taking a DOAC and 23% were taking a vitamin K antagonist
• Three potential causes of breakthrough stroke were assessed:^*
  1. Concomitant use of medicines with potential interactions – cytochrome P450 inducers (e.g. rifampicin, carbamazepine, phenytoin) or inhibitors (e.g. ciprofloxacin, sulfamethoxazole), proton pump inhibitors
  2. Competing aetiologies – any cause other than cardiac embolism, i.e. large artery atherosclerosis, small vessel occlusion, other or undetermined aetiology
  3. Active cancer – an initial or recurrent cancer diagnosis or cancer treatment within six months of the index event
• The primary outcome was the 90-day occurrence of a new ischaemic stroke, defined as a new neurological deficit associated with an acute ischaemic lesion identified on brain imaging (i.e. a recurrent stroke following the index event)

* Other potential causes of breakthrough stroke (e.g. renal or hepatic dysfunction, obesity, malabsorption syndromes, chronic inflammatory conditions) were not assessed in this study, as relevant patient data were not available in the ASPERA-R data set

Results

• Potential causes of breakthrough stroke were identified for 44% of participants; 33% had a single potential cause identified, while 11% had more than one
• The risk of recurrent stroke was approximately doubled in patients with ≥ 1 identified potential cause of breakthrough stroke relative to those without identified potential causes (HR = 2.04, 95% CI = 1.18 – 3.53)
  • A higher proportion of minor stroke (National Institute of Health Stroke Scale [NIHSS] ≤ 5) was also reported for patients with ≥ 1 potential cause identified relative to those with no potential causes identified (34% versus 27%). The median NIHSS and prevalence of large vessel occlusion were also lower in this group.
• Concomitant use of medicines with known interactions was the most frequently identified potential cause (28%), mainly proton pump inhibitors (27%). Use of antiseizure medicines (2%), H₂-receptor antagonists (e.g. cimetidine), dexamethasone and ketoconazole (all < 0.5%, respectively) was also reported.
  • The results showed that patients who took concomitant medicines with known interactions did not have an increased risk of new ischaemic stroke relative to those who were not taking any of these medicines
  • However, the risk of 90-day myocardial infarction (a secondary outcome) was increased by approximately three-fold (HR 3.26, 95% CI = 1.30 – 8.17) in patients taking medicines with known interactions with oral anticoagulants
• Competing aetiology was identified as a potential cause of breakthrough stroke in 24% of patients, including intra- or extra-cranial large artery atherosclerosis (15%), lacunar stroke (4%) and other determined aetiology (4%). More than one probable competing aetiology was identified in 2% of patients.
• Active cancer was present in 4% of patients, including genitourinary, gastrointestinal, pulmonary, haematological, breast, other and skin cancers

Conclusions

• Potential causes can be identified in many people with AF taking oral anticoagulants who experience a breakthrough stroke, and having at least one of these factors increases risk
• Interacting medicines alone did not appear to increase stroke risk, although it did increase the risk of myocardial infarction (although other factors may have contributed)
• Although there is mixed evidence regarding an interaction between proton pump inhibitors and oral anticoagulants, over one-quarter of study participants were taking this class of medicine, making it an important potentially modifiable factor. At a practical level, this could prompt a conversation about risk-benefit balance and whether medicines with known interactions are essential in the patient’s medicine regimen.
• The authors conclude that the results of the study highlight the need for personalised secondary prevention approaches that go beyond reliance on sufficient anticoagulation alone for patients with AF who have had a breakthrough ischaemic event