Increasing evidence demonstrates a wide range of benefits of SGLT-2 inhibitors across cardio-renal-metabolic health outcomes. Funding restrictions are a limitation in some cases, but the strong consensus from both international guidelines and local experts is that a SGLT-2 inhibitor should be considered for any patient with type 2 diabetes, heart failure or chronic kidney disease.

This article covers everything you need to know about SGLT-2 inhibitors, including how to safely prescribe empagliflozin and practical strategies for preventing and managing key adverse effects associated with treatment.

Read the article here

The pharmacological actions of ACE inhibitors and ARBs include reduced glomerular filtration and blood pressure and raised serum potassium. In most cases these effects result in therapeutic benefit. However, these medicines can cause clinically significant hyperkalaemia, renal impairment or hypotension in patients with pre-existing risk factors, e.g. volume depletion, reduced renal function, heart failure, diabetes, concurrent use of diuretics and/or NSAIDs.

This audit helps primary healthcare professionals ensure they are requesting appropriate baseline testing (serum creatinine, electrolytes and blood pressure) before prescribing ACE inhibitors and ARBs to identify patients at increased risk of adverse effects.

Read the audit here

The bpac^nz COPD resources have undergone a full revision to align with the New Zealand COPD Guidelines: 2025 Update. Spirometry remains essential to confirm a COPD diagnosis and where appropriate, prompt escalation to bronchodilator combination inhalers is recommended for symptom control. Triple treatment with a LAMA, LABA and an inhaled corticosteroid, in a single inhaler, provides clinicians with an effective tool to manage patients (who meet Special Authority criteria) at risk of exacerbations, but may not be clinically appropriate for everyone.

Read the article here. A B-QuiCK summary is also available.

Coming soon: The bpac^nz COPD prescribing tools are currently being re-developed to align with the updated New Zealand COPD Guidelines

A new safety lock mechanism is being introduced to enoxaparin sodium injections (Clexane), most often used for the prevention of venous thromboembolism. The new safety lock mechanism (ERIS) automatically releases a safety shield as the needle is withdrawn from the injection site, removing the need for a manual push or click. This design is considered to be safer, reducing the risk of needlestick injuries. Administration information is available from the supplier, here.

The new products have been listed on the Pharmaceutical Schedule since 1^st September, 2026, however, the transition to these is anticipated to occur at different stages between now and February, 2027, depending on the presentation strength. View details here.

There has been recent attention in the media on codeine tablets following ongoing supply issues affecting all strengths; supply is limited, and availability is likely to vary between pharmacies. Stock of 15 mg tablets has now arrived in the country, but it may take up to two weeks to reach pharmacies. A shipment of the 30 mg and 60 mg strengths is expected to arrive in mid-September. Click here for the latest supply information.

By 2030, the target is for 90% of people to receive at least one dose of the HPV vaccine by age 15 years. The latest HPV vaccination data show that coverage for this group is at approximately 68%, so progress is being made towards achieving this goal.

Participation in cervical screening has increased since HPV testing was introduced, from approximately 68% in 2023 to 78% in 2025. While this is slightly below the Programme’s target of 80%, the increase in cervical screening coverage is encouraging.

This is a timely reminder to opportunistically check whether eligible patients are up to date with HPV vaccination and cervical screening. A bpac^nz clinical audit is available for identifying patients who are not participating in regular cervical screening.

Contributed by Associate Professor Sara Filoche, Head of Department, Obstetrics and Gynaecology, University of Otago, Wellington and Dr Judy Ormandy, Clinical Obstetrician and Gynaecologist, University of Otago, Wellington.

Being referred for colposcopy can be an unfamiliar and often anxiety-provoking experience. Many wāhine tell us they are unsure what to expect, what the procedure involves, or what questions to ask. Colposcopy 101 is a consumer resource about colposcopy co-designed with wāhine and Kōpū Collective. It is available to read online, or download, at the Kōpū Collective website. It has myth-busters framed around Q&As (e.g., Can I attend my appointment if I have my period? How did I get HPV? Can I still have sex?). The resource also includes information about ‘What to expect’ and space for people to write down questions for their nurse or doctor. By addressing common concerns, using plain language, and reflecting wāhine experiences, Colposcopy 101 can support informed decision-making, reduce anxiety, and help patients feel better prepared for their appointment.

Often information about colposcopy places emphasis on clinical information, utilising clinical language. We wanted to design a resource that could meet both clinical information standards and consumer information needs. We did this through a co-design process. Our approach was based around the question “What would you have liked to have known?”. The process involved iterative engagement with, and feedback from, wāhine who had experience of colposcopy. We worked with an Indigenous design agency (IDIA) to embed language, design aesthetic and cultural responsiveness throughout.

Kōpū Collective is a partnership between Māori health providers, support services, health professionals, clinicians, researchers and non-Indigenous researchers and clinicians and hospital services. Centring wāhine Māori, we provide culturally safe and accessible diagnostic colposcopy and Lletz treatment services based in the community in the Wellington region. Through our work we have had the opportunity to develop more culturally responsive and accessible information to support wāhine and people needing colposcopy. We hope Colposcopy 101 supports wāhine and whānau to feel informed, prepared and confident when attending colposcopy appointments, while demonstrating the value of co-designed consumer resources in improving healthcare experiences. We’d like to thank all the wāhine who have been involved with creating this resource – your contributions have increased the mana (authority) of the work we do.

For more information, please contact Dr Judy Ormandy: judy.ormandy@otago.ac.nz

Original artworks by Josephine Teu Campbell and Maringikura Mary Campbell

ACC45 (Injury claim) improvements include:

• A new return-to-work support section so that requests are more easily captured (also alignment of this section between ACC45 and ACC18 forms)
• Different levels of work capacity will be able to be specified on a single certificate rather than having to do both the ACC45 and ACC18 in the same consultation
• Two optional questions will be included that will assist ACC to understand the access, experience and outcomes of people with disabilities
• Specific details will be able to be added to improve requests for rehabilitation and assistance
• Consultations will be able to be noted as in-person or telehealth

ACC18 (Medical certification) improvements include:

• A new section to request support for a patient to return to work (aligning with the ACC45)
• Better capability to request rehabilitation and assistance including the ability to provide more detail about what is needed
• If a patient is not working (a non-earner) and therefore does not require time off work, the incapacity section will be hidden, reducing the need to enter information that is irrelevant
• Improvement to the “Contact Me” option to allow more efficient and consistent handling of requests
• Consultations will be able to be noted as in-person or telehealth

Medsafe is reminding clinicians to consider patient-specific risk factors when prescribing rosuvastatin. This follows a report to the New Zealand Pharmacovigilance Database of a person of Asian ethnicity who was switched from another statin to rosuvastatin 40 mg per day and developed acute kidney injury, muscle pain, increased creatine phosphokinase and hyperkalaemia.

As rosuvastatin is the most potent statin available, the recommended starting dose for all patients (i.e. statin naïve or switching from another statin) is 5 mg or 10 mg, once daily. Skeletal muscle toxicity is an established adverse effect of statins, and the risk of toxicity with rosuvastatin is increased in some groups, e.g. Asian ethnicity, severe renal or hepatic impairment, older age, concomitant use of interacting medicines, genetic polymorphisms. The recommended starting dose for these patients is 5 mg, once daily. The dose of rosuvastatin can be increased after four weeks; the maximum recommended dose is usually 20 mg per day, but this depends on individual risk factors. The 40 mg strength should only be considered under specialist supervision for some patients with an inadequate response to the 20 mg dose.

Patients taking a statin should be advised to report any unexplained muscle pain, tenderness or weakness as soon as possible, particularly if they have accompanying malaise or fever. Read the full article here.

Special Authority criteria are being removed from rosuvastatin on 1^st October, 2026; see Bulletin 151 for details

Ocular adverse effects, such as increased intraocular pressure, dry eyes, diplopia and glaucoma, have been reported with the use of psychostimulant medicines for ADHD, i.e. methylphenidate, lisdexamfetamine and dexamfetamine. Pre-treatment assessment and ongoing monitoring is required for patients with a history of increased intraocular pressure or glaucoma, or risk factors for acute angle-closure glaucoma, e.g. significant hyperopia (far sightedness); see individual medicine data sheets for specific recommendations. Patients taking psychostimulant medicines for ADHD should be advised to report any visual disturbance or changes to their vision during treatment. Read the full article here.

• This was a retrospective cohort study of electronic medical data obtained from mother-infant pairs in Northern California. A total of 78,644 infants aged 0 – 6 months born between July, 2021, and June, 2023, were included.
• The median maternal age was 31 years. Maternal vaccination status was classified based on the timing of the last mRNA-based COVID-19 vaccination prior to delivery.
• Maternal COVID-19 vaccination during pregnancy was recorded for just under half of the infants (44%); 30% of infants were born to mothers who were vaccinated prior to pregnancy and the remaining 27% were born to mothers who had never been vaccinated against COVID-19
• The primary outcome was COVID-19 in infants aged under six months. The secondary outcome was COVID-19-related hospitalisation in infants aged under six months.
  • Vaccine effectiveness was defined as the percentage reduction in outcome rate with vaccination, i.e. (1 – hazard ratio [HR]) × 100%
• Results were adjusted for potential confounders, e.g. maternal age, race/ethnicity, parity, co-morbidities, history of COVID-19 before or during pregnancy

Results

• Approximately 5% of infants aged under six months were diagnosed with COVID-19 and 0.1% were hospitalised due to COVID-19
• Maternal vaccination prior to pregnancy did not protect against COVID-19 or associated hospitalisation in infants, regardless of the time between vaccination and pregnancy onset
• Maternal vaccination at any time during pregnancy reduced the rate of COVID-19 in infants aged under two months by approximately 38% (95% CI = 24.8 – 48.6), relative to no maternal vaccination at any time
• Maternal vaccination at any time during pregnancy also reduced the rate of hospitalisation due to COVID-19 in infants aged under six months by approximately 53% (95% CI = 11.1 – 75.1), relative to no maternal vaccination at any time
• When effectiveness was analysed by trimester, only vaccination in the third trimester significantly reduced the rate of COVID-19 and COVID-19-related hospitalisation in infants aged under six months, relative to no maternal vaccination at any time (reductions of 19%, 95% CI = 8.6 – 28.6, and 65%, 95% CI = 12.3 – 85.7, respectively)
  • Vaccination in the third trimester also reduced the rate of COVID-19 in infants aged under six months by approximately 24% (95% CI = 12.1 – 33.9) relative to pre-pregnancy vaccination

Conclusions

• This study demonstrates that maternal COVID-19 vaccination during pregnancy provides protection against COVID-19 and associated hospitalisation in infants, unlike vaccination prior to pregnancy
  • These findings support additional value with COVID-19 vaccination during pregnancy in people who have not previously been vaccinated
• Also consider the potential benefit associated with an additional COVID-19 vaccination during pregnancy for people who received their last dose before becoming pregnant
• Although the findings of this study suggest that vaccination during the third trimester may be most effective at providing infant protection, vaccination early in pregnancy is beneficial for preventing maternal infection and associated complications
  • In practice, vaccination at any time during pregnancy will be beneficial in people who were previously unvaccinated