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Published: 9th October, 2026
Contents
New from bpacnz: What your lipid test means for you
We have published an updated version of the popular bpacnz patient information sheet: What your lipid test means for you. This sheet is intended to support discussions with patients about lipid testing, cardiovascular health and cholesterol management. Our focus is usually on education for clinicians, however, from time to time, we think: wouldn’t it be easier if you had something to hand out to the patient to explain all of this?
This patient resource explains the different results in a lipid panel test and what these mean in relation to health. It includes space for clinicians to record a patient’s total cholesterol, triglycerides, HDL-C, LDL-C, total cholesterol/HDL ratio and non-HDL-C results and individualised targets. The optional full version of the sheet includes extended information on the effects that different dietary fats have on lipid levels and provides advice on making healthy food choices.
The bpacnz patient information sheets are designed to support primary care consultations and can be downloaded and printed, or the link sent to patients via text or email. Other bpacnz patient information sheets include:
In case you missed it – Upfront: Hip dysplasia in adolescents and young adults
In most cases, a young, active patient presenting with groin or hip pain is likely to have a muscular strain. However, in a small number of these patients, the underlying problem will actually be a structurally shallow acetabulum, i.e. hip dysplasia. This can either have persisted quietly since infancy or developed during adolescent growth. Hip dysplasia is one of the leading causes of hip osteoarthritis before the age of 50 years, and outcomes are substantially better when it is recognised early.
Guest author, Orthopaedic Surgeon, Dr Matthew Boyle, examines what causes hip dysplasia in adolescents and young adults, how it relates to infant developmental dysplasia of the hip, and the role of primary care in the diagnosis and management of patients.
Read the full article here
Rewind: Wrap-up of recent key messages
Key dates and updates on news items from recent editions of Best Practice Bulletin:
- The range of funded medicines and clinical services that can be offered in community pharmacy has been extended; see Bulletin 157
- The Medical Council of New Zealand has announced that physician associates are now a regulated health profession in New Zealand and registration applications are open. Read more here. The framework for regulating physician associates was announced earlier this year (as reported in Bulletin 151).
- Applications to join the Pharmac Pharmacology and Therapeutics Advisory Committee (PTAC) close on Monday, 12th October; see Bulletin 157
- Stock of tamsulosin has arrived in the country following a period of limited supply (as last reported in Bulletin 155). A further shipment is expected mid-October, and stat dispensing is anticipated to be reinstated sometime after this.
- The supply issues affecting Locorten-Vioform ear drops (reported in Bulletin 143) and the Tryzan brand of ramipril (last reported in Bulletin 152) are ongoing and expected to continue until early 2027. Alternative brands and products are available.
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.
Supply issues affecting fluconazole 150 mg capsules
The Mylan brand of fluconazole 150 mg capsules, an antifungal, is unavailable due to manufacturing issues. Supply issues have been ongoing for some time; an alternative brand (Flucazole) has been available since April, 2026. Pharmac has announced that another alternative brand (APO Health Fluconazole One) was listed on the Pharmaceutical Schedule from 1st October, 2026. However, this brand is not approved by Medsafe, therefore will need to be prescribed for supply under Section 29A of the Medicines Act. A re-supply date of the Mylan brand is yet to be announced.
Fluconazole 150 mg capsules were recently added to the Extended Pharmacy Services (as reported in Bulletin 157), however, medicines that are not approved by Medsafe (i.e. Section 29 medicines) cannot be supplied via this pathway.
Venlafaxine 75 mg capsules in limited supply
Stock of venlafaxine 75 mg capsules (Enlafax XR), an antidepressant, is expected to run out at the supplier level by mid-October. Other strengths are not affected. An alternative brand (Venlofex) has been listed on the Pharmaceutical Schedule, however, it will not be available for pharmacies to order until mid-October. This brand is not approved by Medsafe, therefore will need to be prescribed for supply under Section 29A of the Medicines Act. If existing supplies run out before new stock arrives, pharmacists may dispense two 37.5 mg capsules to make up the 75 mg dose. Re-supply of the Enlafax XR brand is currently expected in November.
Changes to controlled drugs regulations
The Ministry of Health, Manatū Hauora, has announced a series of changes to controlled drug regulations that are anticipated to modernise requirements and improve efficiency across the system. The Misuse of Drugs Amendment Regulations (No 2) 2026 came into effect on 1st October, 2026. Some of the key changes include:
- The requirement to stocktake controlled drugs on 30th June and 31st December each year has been removed. Stocktakes can now occur on any date but they must happen at least every six months.
- The requirement for controlled drug registers to be kept only in a bound paper format has been removed. Registers can now also be stored electronically if the electronic system meets specific requirements.
- The expiry date for opioid substitution treatment prescriptions has been extended from seven days to 28 days after the date of the prescription
View the full legislation here
Don’t forget about Legionnaires’ disease
Health New Zealand, Te Whatu Ora, is reminding people to be aware of the risk of Legionnaires’ disease (a form of legionellosis) associated with the inhalation of Legionella bacteria from bags of compost and potting mix. Legionellosis can range from a mild infection (Pontiac fever), characterised by self-limiting flu-like symptoms, to severe pneumonia (Legionnaires’ disease). There have been 152 confirmed cases of legionellosis (all causes) between September, 2025, and August, 2026; in 135 of these cases, the patient was hospitalised.
When a patient presents with symptoms and signs of an acute febrile (flu-like) illness or pneumonia, consider the possibility of Legionella as a cause if they have a recent history of potting mix or compost exposure. Legionellosis is notifiable on suspicion, irrespective of symptom severity. Guidance for healthcare professionals is available here.
Read more
Legionellosis is most common in warmer months (although it can occur at any time) and is particularly associated with use of potting mix or compost (usually L. longbeachae) or exposure to a contaminated water source (usually L. pneumophila), e.g. spa pools, rainwater tanks. Risk factors for more severe infection include older age (aged > 50 years), smoking, chronic respiratory disease and immunosuppression.
To prevent Legionella infection when handling compost or potting mix, patients can be advised to:
- Work in a well-ventilated or outdoor area
- Wear a face mask (preferably a N95 mask) and gloves
- Open bags away from their face
- Dampen down the product before using it to reduce dust
- Wash their hands after use, before touching their face or removing their face mask
Patient information on legionellosis is available from: https://info.health.nz/conditions-treatments/lungs/legionnaires-disease-legionellosis
For further information on community-acquired pneumonia, including when caused by Legionella, see: https://bpac.org.nz/2024/pneumonia.aspx
New type 2 diabetes guidance for children and adolescents
New consensus guidelines on the screening, assessment and management of type 2 diabetes in children and adolescents have been published by the Australia and New Zealand Society for Paediatric Endocrinology and Diabetes. The guidance updates recommendations from the previous version of the guidelines (2020) across a range of topics, including:
- Intergenerational risk of type 2 diabetes
- The impact of social determinants of health on type 2 diabetes risk
- Different phenotypes of youth-onset type 2 diabetes
- Screening algorithm for youth at risk of type 2 diabetes
- Psychological health and wellbeing
- Continuous glucose monitoring use
- Treatment, monitoring, assessment and management of co-morbidities and complications
- Management of youth-onset type 2 diabetes, including within primary care
The guidelines have been endorsed by clinical organisations in Australia and New Zealand, including the Royal New Zealand College of General Practitioners (RNZCGP) and the New Zealand Society for the Study of Diabetes (NZSSD).
Some of the practical points for primary care include:
- Be aware of the following risk factors for youth-onset type 2 diabetes: overweight/obesity, in-utero exposure to maternal diabetes, first-degree relative with type 2 diabetes, signs of insulin resistance (acanthosis nigricans), co-morbid conditions associated with obesity/metabolic syndrome (e.g. hypertension, dyslipidaemia), antipsychotic medicine use
- Screening for type 2 diabetes is recommended from age eight years in people of Māori or Pacific ethnicity if they have any of the above risk factors (see Figure 2 in the guideline)
- People of other high-risk ethnicities (e.g. South East Asian) should be screened from age ten years if they have overweight/obesity and at least one other risk factor
- Diagnostic criteria for youth-onset type 2 diabetes are the same as adults. See Box 2 in the guideline for details. The possibility of other forms of diabetes should be considered in discussion with paediatric/youth diabetes services.
- Following diagnosis, patients with youth-onset type 2 diabetes will typically be under the care of a specialist diabetes multidisciplinary team. This generally includes treatment, education and ongoing follow-up.
- Primary care is likely to be involved in ongoing medicine prescribing, monitoring for co-morbidities and the development of any complications, providing support to the patient and their family/whānau and facilitating engagement with other health services
Know Your Period: New patient resource about abnormal uterine bleeding
Abnormal uterine bleeding (AUB) is a common gynaecological condition that affects many people in New Zealand. AUB can have a significant impact on a person’s quality of life, and it may be a sign of serious underlying pathology. A national clinical guideline on the assessment and management of AUB was published in February this year, creating a more consistent and equitable health pathway and referral criteria for females of reproductive age. A new consumer website has been created to complement the guideline: www.knowyourperiod.nz. The website, developed in partnership with the University of Otago, University of Auckland and Indigenous Design & Innovation Aotearoa, helps people to understand what ‘normal’ and ‘abnormal’ menstruation is and when to seek medical advice.
Read more about Know Your Period
Contributed by Associate Professor Sara Filoche, Head of Department, Obstetrics and Gynaecology, University of Otago, Wellington.
“How do I know if my period is abnormal?” Many women/wāhine tell us that they are unsure about whether their periods are normal or not. One of the problems is that abnormal periods become peoples normal – and this is a really important consideration for supporting timely access to care. The people and wāhine we spoke to shared that they couldn’t find information that talked to their experiences of their periods, and particularly, information from Aotearoa New Zealand. This was the catalyst for the development of the Know Your Period website.
We wanted to design a resource that involved people with lived experiences, was clinically relevant, culturally responsive and inclusive for diverse audiences (to include an easy read version).
The Homepage welcomes people to the space, talks about inclusive language use and introduces three people sharing their experiences of AUB. The “About AUB” tab has five sections which cover: What is a period?; Normal periods; AUB; Tracking your periods; and Diagnosing AUB. People are advised that they are the best person to know if their period has changed or if they have always been outside of what is commonly considered ‘normal’. A series of questions are included as prompts for people to review the impact of their periods and if these symptoms have lasted longer than six months. For example, “Are you taking spare clothes to work/school in case of having a period accident?”, “Are you staying in more during your periods?”. There are also tools and tips for people to track their periods.
The FIGO classification system for ascertaining AUB, aligned with the Aotearoa New Zealand national clinical guidelines, has been mapped to types of questions that people could be asked by their healthcare professional. For example, for the category of frequency, the medical description and definition is included so people could expect to answer such a question, and understand why their healthcare professional might ask about frequency of their periods.
We hope Know Your Period website supports wāhine and whānau to feel informed, and prepared to have discussions with their doctors, 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.
For more information, please contact Dr Parimala Kanagasabai: parimala.kanagasabai@otago.ac.nz
Artwork by Georgina Gifford at Indigenous Design & Innovation Aotearoa
Mental Health Awareness Week (12th – 18th October): Belonging matters
Next week (12th – 18th October) is Mental Health Awareness Week. The theme for this year is: Belonging matters. It can often be difficult for healthcare professionals to share concerns about their own mental wellbeing, particularly when they are usually the ones caring for others. Fear of stigma or losing status within the medical community can be barriers to disclosing mental health challenges. Feeling included, seen and valued at work helps to break down these barriers and make it easier to initiate conversations about mental health without fear of judgement.
We all have a role in fostering belonging in the workplace. If you are struggling, let someone know. Make it routine to ask your colleagues, "are you okay?". Treat your own mental health, and that of your colleagues, with the same kindness and attention that you would for a patient.
Read more about this year’s theme
NZF updates for October + practice highlight on antidepressant withdrawal
Significant changes to the NZF in the October, 2026, release include:
- Cautions, hepatic and renal impairment and dosing regimen updated for rosuvastatin
- Contraindications and cautions updated for prednisone
- Caution added for calcipotriol + betamethasone – Daivobet gel contains a peanut oil-derived excipient
- The naproxen sodium and naproxen monographs have been combined into a single naproxen monograph. Cautions, pre-treatment screening, monitoring, hepatic and renal impairment, dosing regimen and patient advice have also been updated.
- Pregnancy advice updated for nifedipine – contraindicated by manufacturer before week 20 gestation has been removed
- Dosing regimen for lidocaine + tetracaine + adrenaline updated with new products (not funded)
- Indications, cautions and patient advice updated for mycophenolate mofetil. New sections on pre-treatment screening and monitoring have been added.
- Updated therapeutic notes:
You can read about all the changes in the October release, here. Also read about any significant changes to the NZF for Children (NZFC), here.
NZF practice highlight: Antidepressant withdrawal
This month, the NZF team highlight antidepressant withdrawal and provide practical strategies for identification and proactive management:
- Risk of antidepressant withdrawal increases with some antidepressants (e.g. paroxetine, venlafaxine), treatment duration, dose and history of withdrawal symptoms
- Psychological symptoms that have a rapid onset following discontinuation and improve after reinstating treatment generally indicate withdrawal rather than relapse, particularly if associated with physical symptoms, e.g. nausea, dizziness, “brain zaps”
- Anticipate and proactively manage withdrawal; when initiating an antidepressant, discuss the intended treatment duration, the need for regular review and the importance of not abruptly stopping treatment
- When the decision to discontinue an antidepressant has been made, develop an individualised tapering plan with the patient, discussing realistic expectations around how long the process is likely to take
- Avoid “cold turkey” approaches, alternative day dosing and switching antidepressants solely to reduce withdrawal symptoms
- Consider hyperbolic tapering (i.e. progressively decreasing dose reductions over the course of the taper) to improve withdrawal tolerability, particularly if the patient is at high risk of, or is currently experiencing, problematic symptoms
- See the RELEASE toolkit for specific guidance on antidepressant tapering plans
- Provide support and regular review over the discontinuation period; if withdrawal symptoms are intolerable, review the tapering schedule and adjust as appropriate, e.g. reduce at a slower rate with smaller dose reductions
Podcast of the Week: Antidepressants during pregnancy
In a recent episode of The Good GP, an Australian podcast series, a consultant psychiatrist discusses the topic of antidepressant use during pregnancy. Whether to initiate or continue antidepressants during pregnancy is a challenging decision to make in practice, and this area of research is constantly evolving. A key component of this decision is weighing the potential risks of antidepressant treatment versus the risks of untreated depression during pregnancy.
The podcast covers key factors to consider in the assessment of a patient, the risk of congenital malformations with antidepressants, selection and dosing of antidepressants during pregnancy and other expert insights.
Listen to the podcast here (~24 minutes)
A companion episode to this podcast has now also been published on antidepressants during pregnancy from a pharmacoepidemiologist’s perspective. Listen to the podcast here (19 minutes).
Food for Thought: How should you measure blood pressure?
In a recent issue of Canadian Family Physician, primary care experts discuss a very common clinical question: “Do recommended blood pressure measurement techniques impact the accuracy of readings?”.
Evidence shows that using a blood pressure cuff that is too small is associated with increased systolic and diastolic readings, as is having the patient’s hand positioned in their lap or at their side, if they cross their legs at the knees or have a full bladder at the time of measurement. There is also some evidence that if the patient talks during the measurement, it may increase systolic readings. In contrast, use of an inappropriately large cuff is associated with lower blood pressure readings. Factors that have been shown to not affect readings include crossing the legs at the ankles, placing the cuff over thin sleeve material (as opposed to a bare arm) and the environment, e.g. measuring in a quiet and private environment versus a noisy or public one. Interestingly, the impact of a five-minute pre-measurement rest period differs between patients; it does not make a meaningful difference when systolic blood pressure is < 140 mmHg but has a variable effect when it is ≥ 140 mmHg.
Points for discussion
New Zealand cardiovascular disease guidelines recommend measuring blood pressure using the average of two seated measurements taken at least ten minutes apart, but do not provide guidance on technique. Canadian hypertension guidelines recommend that patients are seated quietly and still, with their feet flat on the floor and their arm bare and supported. Blood pressure measurement should be performed in a quiet calm room, at least 30 minutes after exercise or intake of coffee or tobacco, using an appropriately sized cuff. These recommendations are generally consistent with other international guidelines.
What is your usual technique for measuring blood pressure? How often do you repeat measurement(s) after an unexpectedly high or low reading before making a clinical decision?
The authors highlight that even small errors can have a significant clinical impact, e.g. a 5 mmHg reduction in systolic blood pressure is associated with a 10% reduction in major cardiovascular events. The magnitude of the difference in systolic blood pressure readings approached or exceeded 5 mmHg for many of the factors examined.
Do you routinely consider technique as a potential source of error for blood pressure readings?
What are the potential clinical implications of blood pressure measurement errors? In which situations could these errors have a higher clinical significance?
The impact of a five-minute pre-measurement rest period differs depending on the patient’s systolic blood pressure. Using an inappropriately small cuff also has a greater impact on readings for patients with a larger arm circumference.
What factors have you noticed influence blood pressure readings? Do they differ between patients?
Did any of the factors discussed in this article surprise you? How do you think awareness of their potential impact will change your clinical practice?
Nickonchuk T, Lindblad AJ, Perry D, et al. Blood pressure measurement techniques. Can Fam Physician 2026;72:554–554. doi:10.46747/cfp.7209554.
Let us know how we did: Food for Thought is a new style of segment for Best Practice Bulletin – do you like this format, or do you prefer the conventional full Paper of the Week write-up?
This Bulletin is supported by the South Link Education Trust
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