Browse bulletin items by A-Z

Published: 8th December, 2023


New article - Accelerated silicosis: diagnosis of an occupational disease

Accelerated silicosis is a progressive respiratory condition caused by exposure to respirable crystalline silica. Dry cutting artificial stone produces very high concentrations of ultrafine silica dust that is deposited in the lungs, causing inflammation and fibrosis. People can be exposed to silica dust from artificial stone for many years before they develop symptoms. Accelerated silicosis has recently emerged as a serious occupational health condition, mainly affecting people working with artificial stone benchtops. Increasing numbers of these workers will likely present in primary care with either a history of silica dust exposure or general health concerns.

The Accelerated Silicosis Assessment Pathway has been established to identify and assess those who have been exposed to silica dust while fabricating artificial stone. WorkSafe is encouraging workers to contact their primary care clinic for assessment. Once a diagnosis of accelerated silicosis has been made, there are no effective curative treatments; management is symptomatic and supportive. This highlights the importance of workplace safety and prevention strategies. Clinicians should be familiar with workplace safety recommendations that reduce silica exposure as these can guide discussions with people who may be at risk.

The full article can be accessed here

Navigating the last days of life: peer group discussion for general practice

We recently published a comprehensive resource aiming to educate and support primary healthcare professionals in caring for patients during the last days of life. This was developed with the support of Te Aho o Te Kahu, Cancer Control Agency, and contextualises information from the Ministry of Health, Manatū Hauora, “Te Ara Whakapiri: Principles and guidance for the last days of life” resources specifically for general practice.

As a continuation of this theme, we have now released a series of questions that can be used as discussion points for peer groups or self-reflection of practice. Is your practice regularly involved in caring for people during the last days of life? What symptoms do you find are the most complex to manage? How do you reduce the risk of unplanned hospital admissions?

View the peer group discussion here

Other recent resources from bpacnz

Oral anticoagulant selection in primary care: Direct oral anticoagulants (DOACs) such as dabigatran and rivaroxaban are now established as the “go to” choice in primary care for prevention of thromboembolic events in patients at increased risk. DOACs have a superior clinical efficacy and numerous practical advantages, more rapid onset if action, fewer medicines and food interactions, compared with the conventional option, warfarin, however, oral anticoagulant selection should always be individualised. Warfarin is still sometimes required on a case-by-case basis in patients with specific co-morbidities or characteristics, e.g. mechanical heart valves, moderate-to-severe mitral stenosis or severe liver disease. Regardless of the option selected, ongoing management involves consideration of modifiable risk factors for bleeding, treatment adherence and monitoring for adverse effects.

Updated - Revisiting opioid use in New Zealand: how does your prescribing compare: We have updated our report on national opioid use between 2017 and 2021 with dispensing data from 2022. A new-look interactive graph format has been added and allows comparison between New Zealand regions in 2020 and 2022. The personalised data section has been updated to also include 2022 statistics. Have you looked at your 2022 data yet? If you are having trouble logging in, email:

Cough medicines: do they make a difference?: Pharmacists and other staff working in community pharmacies are often tasked with guiding people who present with cough on appropriate management strategies. However, as there are a myriad of products available, with differing claims and extent of effectiveness, knowing which product(s) to recommend can sometimes be difficult.

Alert Communication update: sodium valproate use in males

In May, 2023, Medsafe issued an Alert Communication on the use of sodium valproate (Epilim) in “people who can father a child” based on evidence of a potential increased risk of neurodevelopmental disorders in children after paternal use of sodium valproate at the time of conception; this was covered in Bulletin 76. Medsafe has now updated the original Alert Communication with additional information that the potential increased risk of neurodevelopmental disorders in children is present following paternal use of sodium valproate up to three months before conception.

Males who take sodium valproate should be advised to use contraception during and for at least three months after stopping this medicine. They should also avoid donating sperm during this time period. Data sheets and consumer medicine information leaflets have been updated to reflect this; educational materials will be updated soon.

It takes approximately three months for new sperm to fully develop, but it is unknown if there are also potential risks to children conceived more than three months after the father stops taking sodium valproate. Males taking sodium valproate should be informed about this potential risk, and those who are planning parenthood soon may consider switching to an alternative treatment. This conversation should be revisited annually.

A letter for healthcare professionals from the manufacturer about this risk is available here.

N.B. These recommendations are based on evidence from a retrospective observational study in Denmark, Norway and Sweden. The results of this study have not been formally published at this stage. Read more about the study here. Medsafe discusses the results of the study here, along with updated figures after a second analysis of the data, as discussed in a European Medicines Agency review here.

The risk of adverse effects of antiepileptic medicines for females of reproductive age is already well documented, and precautions around effective contraception for females also apply. Read more here.

Latest edition of Prescriber Update released

The December edition of Prescriber Update has been published. Particular items of interest include:

View the full edition here

Medicines supply issues: ciprofloxacin, escitalopram, olanzapine depot injections, oxycodone

The following issues relating to medicine supply, of particular interest to primary care, have recently been announced. This information is also available in the New Zealand Formulary at the top of the individual monograph for any affected medicine and summarised here.

Invitation to participate in a survey about diagnostic pathways for lung cancer

Lung cancer is the leading cause of cancer-related death in New Zealand. Diagnosis often occurs late when people already have advanced disease, limiting the effectiveness of treatment. Early detection is therefore key to improving lung cancer survival outcomes.

A group of researchers from the University of Otago and the University of Waikato, including a medical oncologist and general practitioners, are undertaking a study to understand the regional differences in diagnostic pathways for people with suspected lung cancer. The group is aiming to identify challenges that primary care faces and determine what support is required to introduce a diagnostic method using liquid biopsy to assess circulating tumour DNA (ctDNA).

General practitioners and other primary care clinicians involved in lung cancer diagnosis are invited to take part in a survey about their clinical practice. The survey is expected to take approximately 15 minutes.

An information sheet for participants can be found here.

To take part in the survey, click here.

ACC Māori cultural competency guidance released

ACC has recently released updated guidance on cultural competency: Te Whānau Māori me ō mahi - Guidance on Māori Cultural Competencies for Providers. The original guideline (published in 2005) focused on cultural competency with the idea that increasing health professionals cultural knowledge and awareness would limit unconscious bias and promote effective communication with Māori, reducing health inequities. The new version was written with input from a range of Māori clinicians and other health professionals and builds upon the original guideline by incorporating cultural safety and anti-racism as further tools to reduce health inequities. It should support healthcare providers when applying Kawa Whakaruruhau; ACC’s Cultural safety and competency policy.

Read the full document here

Further information about Kawa Whakaruruhau for ACC service providers is available here

NZF updates for December

Significant changes to the NZF in the December, 2023, release include:

  • Breast-feeding advice has been updated for moxifloxacin
  • Information regarding prescribing and supply restrictions have been added to the dosing regimen for CNS stimulants/ADHD medicines such as dexamfetamine and methylphenidate
  • An alert and information regarding the change in brand of morphine oral liquid has been added to the morphine salts monograph

You can read about all the changes in the December release here. Also read about any significant changes to the NZF for Children (NZFC), here.

Paper of the Week: Low-dose amitriptyline for IBS

Irritable bowel syndrome (IBS) is a common gastrointestinal condition that can significantly reduce a person’s quality of life. Recommended treatments are dietary changes, lifestyle advice, e.g. stress reduction, and in some cases, probiotics, soluble fibre, antispasmodics, laxatives or antidiarrheals. However, for some people, these interventions are still not adequate for reducing IBS symptoms.

Some international guidelines, e.g. UK NICE guidelines, recommend the use of low-dose tricyclic antidepressants (TCAs) such as amitriptyline and nortriptyline as a second-line option for people with IBS. The mechanism of action for TCAs in this context is uncertain, but is thought to involve their neuromodulatory, analgesic and motility properties, rather than effects on mood. Despite evidence of benefit for TCAs in people with IBS, primary care practitioners may be hesitant to prescribe them based on their adverse effect profile and concerns surrounding anticholinergic burden.

A 2023 study published in The Lancet examined the effect of low-dose amitriptyline on the symptoms of IBS in participants who did not respond to dietary changes and first-line treatment options. This research was specifically focused on the management of IBS symptoms in a primary care setting. The authors found that compared to placebo, participants given low-dose amitriptyline had greater improvements in IBS Severity Scoring System (IBS-SSS) scores and relief of IBS symptoms after six months. Rates of adverse effects were higher after three months for participants taking amitriptyline but comparable for both groups after six months. The lower doses required for TCAs in the context of IBS management may mean that a trial is worth considering for some patients.

Have you prescribed TCAs for patients with IBS? Do the results of this study change your threshold for considering TCAs as a second-line option for IBS?

Ford AC, Wright-Hughes A, Alderson SL, et al. Amitriptyline at Low-Dose and Titrated for Irritable Bowel Syndrome as Second-Line Treatment in primary care (ATLANTIS): a randomised, double-blind, placebo-controlled, phase 3 trial. The Lancet 2023;402:1773–85. doi:10.1016/S0140-6736(23)01523-4

For further information on IBS in primary care, see:

This Bulletin is supported by the South Link Education Trust

If you have any information you would like us to add to our next bulletin, please email:

ASK A COLLEAGUE: Are they receiving these bulletins? Sign up to our mailing list here

© This resource is the subject of copyright which is owned by bpacnz. You may access it, but you may not reproduce it or any part of it except in the limited situations described in the terms of use on our website.

Made with by the bpacnz team

Partner links