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Published: 27th October, 2023


New article: Cough medicines: do they make a difference?

Over-the-counter (OTC) cough medicines, although widely used, are not particularly effective at reducing the severity or duration of acute cough associated with a viral upper respiratory tract infection. Most cough preparations contain medicines that are not recommended for children aged under six years. 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. Click here to read more.

#MedSafetyWeek coming up – updated bpacnz opioid report now available

The eighth annual #MedSafetyWeek is coming up on 6th – 12th November, 2023. This initiative aims to raise awareness of adverse medicine reactions, with the theme this year being 'Who can report?': how patients, doctors, pharmacists and other health professionals can contribute to pharmacovigilance. A media campaign will occur in that week so look out for it; we will be joining in so follow, like and share!

bpacnz has a strong history of advocating for appropriate and safe medicine use, and we have found that reflecting on dispensing data can be an effective way to achieve this goal. Last year, we published a report on national opioid use between 2017 and 2021, highlighting that while overall dispensing had declined over time, there was a small increase in the use of both weak and strong opioids at the end of this period that warranted closer monitoring. This report also included a personalised section for primary care prescribers to review their data from 2021, and editable resources to support safe opioid use, including a pain management plan and an example opioid contract.

We have now updated this opioid report with dispensing data from 2022, demonstrating that national use continues to trend upwards during the “COVID-19 era”. In particular, the relative increase in oxycodone prescribing is a concern, given that morphine is the preferred first-line option if a strong opioid is required. A new-look interactive graph format also allows for comparison between New Zealand regions in 2020 and 2022, and the personalised data section has been updated to also include 2022 statistics.

Is the overlap between increased national opioid use and the “COVID-19 era” causal or coincidental? What explains the significant variation between regions? Has your prescribing changed over time, and how does it compare against your peers?

Click here to explore the updated opioid resource

Dulaglutide/liraglutide Special Authority changes + other Pharmaceutical Schedule updates

The following changes to the Pharmaceutical Schedule of particular interest to primary care, have recently been announced and will be effective from 1st November, 2023:

Lamictal (lamotrigine): new look

GSK has advised of a change in packaging of the Lamictal brand of lamotrigine 25 mg, 50 mg and 100 mg tablets (not funded, unless under an exceptional circumstances approval). This change is due to the introduction of new child-resistant foil blister packaging. The 2 mg and 5 mg tablets are unaffected as they are packaged in a bottle.

Patients taking these tablets should be advised that the packaging will look slightly different but be reassured that there has been no change to the formulation, manufacturer or manufacturing method. An information sheet is available to give to patients here.

Low-dose cannabidiol products reclassified + other recent reclassifications

Medsafe has reclassified low-dose cannabidiol (CBD) from a prescription-only to pharmacist-only medicine. There are currently no approved low-dose CBD products available in New Zealand, but the reclassification means that if such a product becomes approved in the future, registered pharmacists will be able to supply it without a prescription for people aged 18 years and older under certain conditions.

CBD is now classified as:

  • Prescription: “except when elsewhere in the schedule
  • Pharmacist-only (restricted): “when supplied, in medicines with dosing instructions for 150 milligrams or less per day and containing not more than 4.5 grams, when sold in the manufacturer’s original pack that has received consent from the Minister or Director-General, for adults aged 18 years and over, by a registered pharmacist

N.B. The reclassification of low-dose CBD only applies to medicines approved under the Medicines Act 1981. Medicinal cannabis products may also be supplied (if prescribed by a medical practitioner) if they meet the minimum quality standards of the Misuse of Drugs (Medicinal Cannabis) Regulations 2019.

For an overview of medicinal cannabis for health practitioners, see: A medicinal cannabis guide for pharmacists is also available here:

Other recent reclassifications

From 1st October, 2024, some medicines containing naproxen will be reclassified as pharmacist-only and can be supplied with a higher recommended daily dose (> 750 mg/day) than pharmacy-only products (≤ 750 mg/day).

From 1st October, 2024, paracetamol liquid in packs containing ≤ 10 g will be reclassified as pharmacy-only and packs containing > 10 – 50 g will be reclassified as pharmacist-only. N.B. A 200 mL bottle containing 250 mg/5 mL contains 10 g of paracetamol.

From 1st December, 2023, methenamine hippurate (Hiprex, U-Tract) will be reclassified as a pharmacist-only medicine. Currently, methenamine hippurate is unscheduled, i.e. it can be purchased from a supermarket, pharmacy or prescribed (funded) for antimicrobial prophylaxis in those with a history of recurrent urinary tract infections. For further information on the management of lower urinary tract infections, click here.

International Lead Poisoning Prevention Week 2023: 22nd – 28th October

This week is International Lead Poisoning Prevention Week, an initiative from the World Health Organization (WHO) highlighting the negative health impacts of lead exposure. This year, the focus is to “End Childhood Lead Poisoning” and the WHO are calling for a combined effort from governments, health care groups and industry to support this campaign. The removal of lead from petrol and restricting the use of lead paint has reduced lead exposure in many countries, however, more can be done to raise awareness of the dangers of lead exposure and to prevent it occurring, especially in children. Paintwork on older homes and buildings, cots, toys, some painted items manufactured overseas, rainwater tanks with runoff from lead roofs or piping, and contaminated soil are examples of environmental sources of lead in New Zealand.

Resources for Lead Poisoning Prevention Week including training modules for health care providers, posters and patient education material are available from the WHO website.

For further information on lead exposure and reporting notifiable lead levels in New Zealand, see:

National Polio Response Framework released

Manatū Hauora, Ministry of Health, has released the National Polio Outbreak Preparedness and Response Framework for Aotearoa New Zealand, in response to the increase in poliomyelitis activity in countries where polio was considered to be eradicated, e.g. detection in wastewater in the UK, USA and Canada (reported in Bulletin 66). There are currently no cases of poliomyelitis reported in New Zealand (with the last being in 1977), however, this framework has been introduced to provide technical guidance and direction for decision makers and health care professionals in the event of a polio outbreak. The framework also covers the escalation of surveillance measures, if required.

bpacnz focus: Ask about menopause

Menopausal symptoms are experienced by most women, but only some seek treatment, or are aware that treatment is available. Potentially even fewer women are regularly asked by their health care professional about their experience of menopause and proactively offered support or advice about their symptoms. Cultural and ethnic differences, societal barriers and level of engagement in health services can all contribute to women missing out on treatment, if required, which can lead to a reduced quality of life. A lack of knowledge or confidence about the safety of prescribing menopausal hormone therapy among healthcare professionals may also be contributing to this issue.

The challenge: Where appropriate, ask every female patient you see, aged 40 – 60 years, if they have any questions about menopause: what to expect if it hasn’t happened yet, and what they are experiencing if it has. You may be able to offer some quick, simple advice, or invite them to come back to see you, or a colleague, for a dedicated appointment. The objective is to ensure that women understand that menopause is a legitimate reason to seek medical advice and treatment, it is not something to be ashamed about or trivialised, and symptoms can be managed or reduced, they don’t need to just live with it.

For further information on menopausal hormone therapy, including a prescribing algorithm, see:

Paper of the Week: Atopic dermatitis in children with melanin-rich skin

Atopic dermatitis (eczema) is a common dermatological condition in childhood, usually managed in primary care. New Zealand is a multicultural country and primary care clinicians assess and treat dermatological conditions in patients with a spectrum of skin tones. Conventionally, resources used in medical training often focus on symptomology and diagnosis of dermatological conditions in people of European ethnicity. This can lead to an underestimation of symptom severity, misdiagnosis, inappropriate or under-treatment of dermatological conditions in children with melanin-rich skin, in which dermatological conditions may present “outside of the textbook”. An article published in the Australian Journal of General Practice provides an overview of the diagnosis and management of atopic dermatitis in children with skin of colour, including Indigenous Oceanic ethnicities (e.g. Māori and Pacific Peoples), as well as people of Asian, African and Middle Eastern ethnicity.

How confident are you at diagnosing and managing atopic dermatitis (eczema) in children with melanin-rich skin? Are there specific situations that make diagnosing atopic dermatitis more difficult? What have you done to improve your clinical skills when treating atopic dermatitis?

This Bulletin is supported by the South Link Education Trust

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