Published: 1 July, 2022
Patients taking Accuretic require an alternative treatment
It has been reported that recent batches of the combination anti-hypertensive Accuretic (quinapril with hydrochlorothiazide) have been contaminated with small amounts of nitrosamines. PHARMAC has advised that Accuretic will no longer be available, following voluntary recalls worldwide (which began in March, 2022). While the timeframe for this supply issue is uncertain, uncontaminated stock may not be available for more than 12 months.
An estimated 36,000 people in New Zealand are currently prescribed Accuretic and will require an alternative treatment option. Medsafe advises that patients should continue taking Accuretic until they have spoken to a healthcare professional, and should not abruptly stop use. PHARMAC has indicated that financial support will be provided “covering the cost of the GP clinic visit and prescription fees”; an announcement will be made once details are finalised.
There is no alternative brand to Accuretic available; losartan with hydrochlorothiazide is considered a suitable alternative fixed-dose combination treatment. Another option is concurrent use of any ACE inhibitor or ARB and a thiazide or thiazide-like diuretic – adherence issues will need to be taken into consideration.
N.B. The Accupril brand of quinapril has also been voluntarily withdrawn worldwide due to the same contamination issues, however, this is not currently the funded brand of quinapril in New Zealand.
For further information on selecting and prescribing ACE inhibitors,including dosing considerations, see: https://bpac.org.nz/2021/ace.aspx
Risk posed by contamination considered small
Suggested communication to patients
We have provided a sample message that practices may wish to use to communicate with their patients about this issue.
You are currently prescribed Accuretic for your blood pressure. This medicine is no longer available due to a small safety risk if it is used for a long time. Please keep taking your medicine until you have talked to us about changing to a different option. You can wait until your next prescription is due, or if you are worried you can talk to us about it now.
Widened access to flu vaccine
Access to funded influenza vaccination has now been widened for at-risk populations. From April, 2022, access was widened to include all Māori and Pacific people aged 55 to 64 years, and from 1 July, 2022, access is widened further to include children aged 3 – 12 years and people with serious mental health conditions or addictions:
- Major depressive disorder
- Bipolar disorder
- Schizoaffective disorder
- People currently accessing secondary or tertiary mental health or addiction services
Funded access still remains for people aged > 65 years or with chronic health conditions. Click here for the full list of funded access criteria.
N.B. If a person has had COVID-19 infection, influenza vaccine can be safely given once the person is no longer acutely unwell and has completed at least seven days of self-isolation.
For further information about “flu season” for health professionals, see: https://www.influenza.org.nz/
Second COVID-19 boosters
Access to a second COVID-19 booster has been widened to include anyone aged 50 years and older and for people who work in health, residential care or disability care facilities aged 30 years and older. The second booster dose can be administered following a minimum of six months after the previous booster dose and should be postponed until three months after infection with COVID-19.
The following people are also recommended to receive a second booster dose:
- People aged 65 years and older
- Māori and Pacific peoples aged 50 years and older
- People living at a residential aged care and disability care facilities
- Severely immunocompromised people who received a three-dose primary course and a fourth dose as a first booster
- People aged 16 years and older with a medical condition that increases the risk of severe COVID-19 illness
- People aged 16 years and older who live with a disability with significant or complex health needs or multiple co-morbidities
A second booster dose is not needed for young people (particularly those aged less than 30 years) without co-morbidities and healthy pregnant women.
For further information on COVID-19 booster vaccines, see: https://www.health.govt.nz/covid-19-novel-coronavirus/covid-19-vaccines/covid-19-vaccine-information-health-professionals/covid-19-vaccine-policy-statements-and-clinical-guidance#booster
Locorten-Vioform ear drops back in stock
A long-term supply issue for flumetasone pivalate (Locorten-Vioform) ear drops has now been resolved, and stock is once again available. As reported in Bulletin 25 these ear drops have been out of stock since June, 2021, due to problems with the active ingredients. Locorten-Vioform is recommended as an option to treat inflammation with secondary infection in otitis externa and is also appropriate for fungal/yeast infections in addition to aural microsuction for people with chronic suppurative otitis media.
For further information on managing otitis media, click here
Call for interest: ACC pilot study on new concussion management pathway
ACC is piloting a new standardised concussion management pathway; this aims to improve patient outcomes and make it easier for general practitioners to navigate decisions around diagnosis and treatment by reducing referral delays and other logistical barriers. The pathway is being trialled by ACC in the Canterbury and Auckland regions over the next 12 months, partnering with Procare, Pegasus, Auckland University of Technology (AUT) and Manage My Health.
Due to the recent Omicron outbreak, direct referral to a concussion service without the need for prior approval by ACC has been permitted for the past three months. However, this process will end on 31 July, 2022. General practitioners participating in the pilot study will be able to continue referring patients directly to concussion services, without needing ACC prior approval.
The pilot study uses the Brain Injury Screening Tool (BIST), available via the Medtech patient management system. New service item codes have also been established to cover patient co-payments for subsequent assessments by general practitioners participating in this pilot study working under the Cost of Treatment Regulations, Rural General Practice and Urgent Care Clinic contracts.
If you belong to Pegasus or Procare, use Medtech and wish to participate in this pilot, please contact either:
Want to read more about concussion?
bpacnz recently published a suite of resources on the management of patients with concussion in primary care, supported by ACC and open access to all readers. This includes:
N.B. Additional resources are also available to support participants in the ACC concussion pilot study.
New warning and advisory statements for stimulant laxatives
Stimulant laxative products will be required to include new warning and advisory statements regarding the potential for misuse. This decision was made by Medsafe after a consultation process, following a recommendation from the Medicines Adverse Reactions Committee in 2021. Read the full decision here.
Stimulant laxatives, e.g. bisacodyl, glycerol, sennosides/senna, sodium picosulfate, are available through general sale, pharmacy-only and on prescription; there is currently no requirement for warning and advisory statements. Due to concerns over the potential harms of long term or excessive laxative use, warning and advisory statements for patients will be added to stimulant laxatives to ensure they are taken safely and appropriately.
The following statements will be added to stimulant laxatives for oral or rectal use (except glycerol for rectal use only):
- “Does not help with weight loss”
- “Excessive use can be harmful”
- “If symptoms persist seek medical advice”
N.B. Warning and advisory statements do not apply to bowel cleansing preparations.
The Labels Statements Database will be updated on 1 September, 2022, with the manufacturers of affected products required to comply with these changes by 1 March, 2024.
Pae Ora (Healthy Futures) Bill
As of 1 July, 2022, the Pae Ora (Healthy Futures) Bill has come into force, which serves as the foundation for transforming the New Zealand healthcare system. Under this new legal framework, the 20 District Health Boards (DHBs) and their functions are now merged within a single Crown organisation, Health New Zealand (Te Whatu Ora), which is responsible for planning and commissioning health services for the country. Four regional divisions and a range of district offices will be established to enable locality-based decision making, with a strong emphasis on primary care. A new independent Māori Health Authority (Te Aka Whai Ora) has also been established and will work in partnership with Health NZ to commission healthcare and ensure that the needs of Māori communities are met. Two other new entities provide additional dedicated services: Public Health Agency and Ministry of Disabled People (Whaikaha).
We understand that many primary care health professionals will have uncertainty and questions around how these proposed changes will logistically unfold, particularly given their central role and importance within the new healthcare system. It has been stated that “not too much will change in the short-term”, with adjustments being progressively rolled out over time as Health NZ establishes its approach to planning and commissioning services. If you have any questions, the Transition Unit managing the implementation plan can be contacted at:
The catalyst behind the decision to reform the New Zealand healthcare system is persisting inequity.
Internationally, there is no single blueprint for structuring a successful healthcare system, as the operational success depends on country-specific factors, including the socio-political context, economic resources and geographic considerations. In New Zealand, DHBs were initially established to provide communities with an increased role in decision-making, allowing them to be more responsive to their localised needs and challenges. However, the associated fragmentation and differences in healthcare delivery across New Zealand has fostered gaps in access and outcomes between regions and particular groups, including Māori, Pacific peoples, disabled people and vulnerable people.
We have a talented and hard-working health workforce in New Zealand, and to be successful in their practice they need to be enabled by the infrastructure in which they operate. While teething problems are likely during this transition, it is hoped that the change will help reorient our healthcare system and ensure that people receive a consistent quality of care regardless of who they are and where they live.
Coming soon: Recognising and managing OCD in primary care
We recently interviewed Dr Caleb Armstrong, Consultant Psychiatrist and Youth Forensics Specialist, Anteris NZ, about the understanding, recognition and management of patients experiencing obsessive compulsive disorder (OCD), in a primary care setting.
OCD affects approximately 2% of the population and can have a significant impact on quality of life, including relationships, education and employment. Diagnosis in primary care can be challenging due to the variable nature of presentation and reluctance by many patients to report their symptoms. In addition, symptoms of OCD may be misunderstood, or attributed to another mental health or psychiatric condition.
Our interview with Dr Armstrong, along with supporting material, is now in final production and due to be published soon.
Other upcoming topics:
- H.pylori - who to test and how to treat
- Coeliac disease – the latest advice on diagnosis and how to help a patient navigate a gluten-free life, including a personal account.
Watch your inbox in the coming weeks for more details on these new resources.
This Bulletin is supported by the South Link Education Trust
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