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Published: 17 March, 2023


New multimedia slidecast - Osteoarthritis: a focus on exercise

Three main aspects form the foundation of a management strategy for patients with osteoarthritis: education, exercise and weight loss. Other interventions can then be progressively added as required, such as analgesia with NSAIDs or paracetamol.

Bpacnz has recently published a 20-minute multimedia slidecast, exploring the role of exercise in improving pain or loss of function associated with osteoarthritis. To help navigate this topic, we are joined in this narrated slideshow by physiotherapist Associate Professor Ben Darlow (University of Otago, Wellington) and orthopaedic surgeon Mr John Scanelli (Te Whatu Ora Southern; Senior Clinical Lecturer, Dunedin School of Medicine, University of Otago).

View the slidecast here. Printable key practice points are also available here.

In case you missed it – Endometrial cancer: early detection and referral

Uterine cancer is the most prevalent gynaecological cancer in New Zealand, with an average of 627 females newly diagnosed each year (from 2015 – 2020). Endometrial cancer accounts for the majority of uterine cancer diagnoses. Excessive exposure to endogenous or exogenous oestrogen unopposed by progesterone is aetiologically linked to most endometrial cancers. Obesity is one of the most significant risk factors, with an estimated six out of ten diagnoses of endometrial cancer attributed to this.

Read the full article here.

A B-QuiCK summary is also available here.

Potential pertussis outbreak

Te Whatu Ora, Health New Zealand, is asking healthcare professionals to be alert for patients with any symptoms suspicious of pertussis (whooping cough) following concerns of potential community spread. Vaccination (with diphtheria, tetanus and pertussis vaccine, Boostrix) should be strongly encouraged for young children, their caregivers and people who are pregnant. Boostrix is now able to be offered in community pharmacies for eligible people at no cost.

Infants and young children are eligible to received funded Boostrix at ages six weeks, three months and five months. Boosters are available at ages four and eleven years. For people who are pregnant, Boostrix can be administered as a single dose from the second trimester of each pregnancy (funded; recommended from 16 weeks, but at least two weeks before birth). It is also recommended that close family contacts of infants/young children, e.g. parents, grandparents, have a booster dose* to reduce potential spread. A full list of eligibility criteria for funded vaccination can be found here.

*Only funded for parents or primary caregivers of infants admitted to a NICU or Specialist Care Baby Unit for more than three days, who had not been exposed to maternal vaccination at least 14 days prior to birth

This is a timely reminder to opportunistically check whether patients, particularly children, have completed their course of Boostrix and to offer vaccination where appropriate. Some children may have missed out on their scheduled Boostrix vaccine(s) during the last three years due to the COVID-19 pandemic and lockdowns.

COVID-19 antivirals molnupiravir (Lagevrio) and tixagevimab + cilgavimab (Evusheld) no longer recommended by advisory group

Te Whatu Ora, Health New Zealand, has released two position statements from the COVID-19 Therapeutics Technical Advisory Group:

Potential risk of neurotoxicity with cephalosporins

Several reports have been made to the Centre for Adverse Reactions Monitoring (CARM) of potential neurotoxicity associated with cephalosporins, e.g. cefaclor, cefalexin, ceftriaxone. Neurotoxic adverse effects include seizures, myoclonus, compulsion, confusion, encephalopathy, agitation, hallucination and delirium.

In December, 2022, The Medicines Adverse Reactions Committee (MARC) consulted on this potential risk, and determined that although available data are limited, an association between neurotoxicity and the cephalosporin class of antibiotics could not be discounted. The full report can be read here. This safety issue has been highlighted in the latest edition of Prescriber Update.

Avoid use of metoclopramide in children and young adults if possible

As reported in the latest issue of Prescriber Update, Medsafe is reminding clinicians that use of metoclopramide in children and young adults (aged 1 – 19 years) is limited to second-line treatment of certain conditions only (see below) due to the risk of dystonia. This comes following several reports to the Centre for Adverse Reactions Monitoring (CARM) of dystonic reactions in children taking metoclopramide.

Trikafta to be funded from 1 April

Pharmac has announced that Trikafta (elexacaftor with tezacaftor and ivacaftor) will be funded from 1 April, 2023, for people aged ≥ 6 years with cystic fibrosis who meet Special Authority eligibility criteria.

Special Authority can be applied for by any relevant practitioner, but funded treatment will only be dispensed from a Te Whatu Ora inpatient hospital pharmacy (of the patient’s choice). Community pharmacies (including both retail and outpatient pharmacies within Te Whatu Ora hospitals) will not be able to dispense Trikafta due to the high cost of the medicine.

N.B. Some patients may have cystic fibrosis caused by rare mutations that are not covered by this access criteria. Prescribers can apply for a Named Patient Pharmaceutical Assessment (NPPA) for these patients. Pharmac will require evidence that Trikafta works for the specific mutation(s) for treatment to be funded. Further information on NPPA applications is available here.

In Brief: monthly fluoxetine dispensing resumed

The seven day dispensing limit for fluoxetine 20 mg capsules has now been removed; monthly dispensing has therefore resumed. As reported in Bulletin 67, the dispensing limit was put in place as the brand change for fluoxetine from Fluox to Arrow-Fluoxetine occurred earlier than expected, causing a supply issue with Arrow-Fluoxetine.

Paper of the Week: "Is there any chance you could be pregnant?"

Most maternity care is carried out by midwives and obstetricians in New Zealand, but general practitioners still have a role in the general medical care of people who are pregnant, including prescribing routine and acute medicines. The problem is that prescribers may not always be aware that the patient is pregnant when they are treating them.

A study published in the British Journal of General Practice has highlighted a breakdown in communication that can have significant long-term consequences for pregnant patients and their child. The aim of this study was to assess general practitioner awareness of pregnancy and its association with prescribing medicines with potential safety risks. It was found that only 48% of patients who were pregnant had confirmation of pregnancy coded in their patient record and subsequently, these patients were 59% more likely to be prescribed a teratogenic medicine that should have been avoided during pregnancy (odds ratio 1.59; confidence interval 1.49 to 1.70).

This study serves as a reminder that, if appropriate, clinicians should always check a patient’s pregnancy status, especially when prescribing higher risk teratogenic medicines, e.g. isotretinoin, antiepileptics and angiotensin-converting enzyme inhibitors.

Houben E, Swart KM, Steegers EA, et al. GPs’ awareness of pregnancy: trends and association with hazardous medication use. Br J Gen Pract 2023;BJGP.2022.0193. doi:10.3399/BJGP.2022.0193

For further information on considerations regarding medicine safety in pregnancy, see the New Zealand Formulary pregnancy information:

Patient information leaflets from the United Kingdom Teratology Information Service are available at:

This Bulletin is supported by the South Link Education Trust

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