Published: 8 April, 2022
Contents
New article - Weight loss: the options and the evidence
The jury is in – there is no consistent evidence that any one calorie-restricted diet is better than another at achieving weight loss. The overriding principle is simply that "energy in" needs to be less than "energy out". Of course, there are many reasons why one dietary approach may be better than another for an individual patient depending on their co-morbidities, and certainly there is evidence that a plant-based whole foods diet is a better choice for the environment. However, weight loss is a personal journey and what motivates one patient may not be the same for another. We present the options and the evidence from different dietary approaches to pharmacological treatments and surgery.
Read more here
Oral antiviral now available for select patients with COVID-19 in the community
Paxlovid (nirmatrelvir with ritonavir) is an oral antiviral treatment that can be prescribed for patients with COVID-19 in the community who are at risk of severe disease and who meet specific treatment criteria. Nirmatrelvir works by inhibiting the main protease (enzyme) in SARS-CoV-2 that is responsible for viral replication. Ritonavir inhibits metabolism of nirmatrelvir, resulting in increased plasma concentrations.
Treatment consists of taking separate tablets of nirmatrelvir (2 x 150 mg) and ritonavir (1 x 100 mg), twice daily for five days. This dose requires adjustment for patients with moderate renal impairment. Treatment should be initiated within five days of symptom onset.
Further information for health professionals is available from:
Paxlovid can be considered for patients who meet the following criteria:
N.B. regularly check the PHARMAC website for any changes to access criteria
- Patient has confirmed or probable COVID-19, is symptomatic (and symptoms started in the last five days) and is a household contact of a positive case
- Patient is immunocompromised (as per Ministry of Health criteria) and is not expected to mount an adequate immune response regardless of vaccination status; or meets five of the following –
- Any combination of risk conditions as per Ministry of Health criteria (each condition counts as one risk factor)
- Māori or any Pacific ethnicity
- Aged 65 years or over, or aged 50 years or over and not fully vaccinated
- Patient does not require supplemental oxygen to maintain oxygen saturation >93% or at or above baseline for patients with chronic resting hypoxia
- Patient is not using any other oral COVID-19 antiviral treatment
Paxlovid should not be used in patients:
- With severe hepatic or renal impairment
- Who are taking interacting medicines, e.g. simvastatin, amitriptyline, carbamazepine, phenytoin, rifampicin, St John's wort, amiodarone, clozapine, colchicine, triazolam, clopidogrel, domperidone - see NZF for a full list of interactions with nirmatrelvir and with ritonavir. N.B. there is an extensive list of medicines that Paxlovid should not be used concurrently with. Some patients may be able to temporarily stop a medicine to use Paxlovid (or adjust the dose), however, be aware of any recommended washout period. The Liverpool Drug Interactions Group has produced a colour-coded one page interaction table which summarises the potential interactions and provides practical guidance.
- Who are pregnant. N.B. effectiveness of some forms of contraception may be reduced in people using Paxlovid – see NZF for further details
Paxlovid should be used with caution in people with pre-existing hepatic dysfunction. Dose adjustment is required in people with moderate renal impairment.
Flu season has begun
A reminder that resources for health professionals on the 2022 Influenza Vaccination Programme can be found here: www.influenza.org.nz
PHARMAC recently confirmed that the eligibility criteria for funded influenza vaccination would be extended to Māori and Pacific peoples aged 55-64 years. Read more here.
Two common questions that patients may have:
- Can I have an influenza vaccination at the same time as a COVID-19 vaccination? Yes
- Can I have an influenza vaccination if I have had COVID-19? Yes, as soon as you have recovered
Reclassification of pholcodine
Medafe has announced that from 1 December, 2022, any medicine containing pholcodine must be sold as a restricted (pharmacist only) medicine and held in the pharmacist only section of pharmacies. Pholcodine is currently classified as a pharmacy only medicine, i.e. it can be selected off the shelf from a pharmacy.
This decision follows advice from the Medicines Adverse Reaction Committee and the Medicines Classification Committee due to potential safety concerns around the use of this medicine in the absence of pharmacist guidance.
Further information on the decision can be found here (refer to the minutes from the 64th and 65th meetings).
Reminder: API withdrawal from the New Zealand market
API Consumer Brands is closing its Auckland Manufacturing plant and therefore medicines it currently supplies in New Zealand will no longer be available. This affects several funded medicines, including paracetamol, codeine, methadone and citalopram. PHARMAC has been working to find new suppliers for these medicines. A table of affected products is available here and will be regularly updated as new brands are secured.
National consensus guideline for treatment of postpartum haemorrhage
Postpartum haemorrhage (PPH) is a significant cause of perinatal morbidity in New Zealand. The Ministry of Health has released a national consensus guideline with the aim of highlighting early recognition of PPH, standardising care and advice and improving outcomes, including equity for Māori. The guideline is intended for any health professionals who are involved in pregnancy, birth or postpartum care.
New Zealand Formulary updates for April
Significant changes to the NZF in the April, 2022, release include:
Paper of the Week: We won't all get COVID
"Don't worry about going to < insert public place, crowded event, someone's currently infected household > we're all going to get COVID anyway".
Can we have a show of hands of who has heard some variation of this conversation in the past few months? There seems to be an air of inevitability that it is only a matter of time until COVID-19 pays a visit to us all, and many of course have played host already. However, the reality is that a large proportion of people in New Zealand are not going to contract the virus.
Read more
Latest data from the Centers for Disease Control and Prevention in the United States shows that in a population where 86.7% of people aged twelve years or over have had at least one vaccination and 74.1% are fully vaccinated (compared to 96.4% with at least one dose and 95.1% fully vaccinated in New Zealand for the same age range), it is estimated that 43.3% of people have had COVID-19 (based on seroprevalence). Therefore, more than half of people in the United States have not had COVID-19.
This is positive news for us in New Zealand. Although, just because you don’t have COVID now, it doesn’t mean you will never have it (or you may have had it and not known). Infectious disease experts in the United States caution against people who have never had COVID feeling that they are invincible. So, what does make someone less likely to get COVID? Vaccination of course, but the exact duration of this protection is not yet known. Behaviour also plays a significant role – are you in a job with a higher risk of exposure? What is your living situation? What activities do you do? Individual immune and genetic factors also have an influence. A study just published in Nature Genetics has found that people with a certain genetic variant that downregulates angiotensin-converting enzyme 2 (ACE2) expression by 37%, have a 40% reduced risk of SARS-CoV-2 infection; the virus is thought to enter host cells via ACE2. Other variants of this gene result in worse outcomes for infection. The results of this study could be used to target future therapeutic treatments against COVID-19.
So, while most people who contract COVID-19 certainly didn’t intend to, and in fact probably tried very hard not to, if you are one of those who have so far never-been-infected, keep taking all the precautions you can and don't put down your shield just yet. But remember, we are NOT all going to get it anyway...
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