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Published: 4 November, 2022


Increased risk of neurodevelopmental disorders with topiramate

A recently published study in JAMA Neurology has identified an increased risk of neurodevelopmental disorders in children exposed in utero to topiramate. The study, which involved nearly 4.5 million mothers and children in Nordic countries, found a 2.5-fold increase in autism-spectrum disorder and a 3-fold increase in intellectual disability in children born to women taking topiramate compared to women with epilepsy who were not taking any anti-seizure medicines. The risk of neurodevelopmental disorders with topiramate was higher than with sodium valproate.

The results of this study suggest that topiramate poses a similar risk of neurodevelopmental adverse effects as sodium valproate (or potentially higher) and the same level of caution should therefore be applied. Until now, there has been a lack of data to fully assess the magnitude of risk with topiramate. The results of this study have triggered a safety review of topiramate in the United Kingdom.

In New Zealand, topiramate is indicated for epilepsy and migraine prophylaxis in adults. Key points for prescribing any anti-epileptic medicines to females of child-bearing potential:

Bjørk M-H, Zoega H, Leinonen MK, et al. Association of prenatal exposure to antiseizure medication with risk of autism and intellectual disability. JAMA Neurol (2022).

For further reading, also see: “Balancing the benefits and risks of prescribing antiepileptic medicines in women.” Bpacnz.

Thank you to Dr Peter Bergin, Neurologist, Auckland, for bringing this study to our attention and sharing resources on this topic.

The seventh annual #MedSafetyWeek is being held from 7th – 13th November 2022. Medicines regulators from 81 countries (and their stakeholders) are coming together for a social media campaign to encourage the reporting of suspected adverse effects of medicines. Look out for our posts!

This year the focus is on health professionals, patients and families/caregivers who report suspected adverse effects and how this contributes to medicines safety.

In New Zealand, suspected adverse effects to medicines and vaccines can be reported to the Centre for Adverse Reactions Monitoring (CARM) or directly via your practice management software.

Update on abortion services in New Zealand

Medicines for early medical abortion now available in the community

As of 1 November, the medicines used for early medical abortion (mifepristone and misoprostol) are available on prescription for dispensing in community pharmacies and on PSO. They may be prescribed by any relevant prescriber.

The New Zealand College of Sexual and Reproductive Health (NZCSRH), in conjunction with the Ministry of Health, has developed theory training in early medical abortion, first trimester vacuum aspiration surgical abortion and point-of-care ultrasound. The development of these training modules has been supported by bpacnz and they will be hosted on the bpacnz website.

A webinar is to be held on 16th November at 7pm, to provide health professionals further information about the first-trimester abortion training modules. To register your interest, click here.

For further information about the NZCSRH training modules, click here.

N.B. A training course for pharmacists about the safe and sensitive dispensing of medicines for early medical abortion is available from the Goodfellow Unit.

DECIDE abortion telehealth service fully up and running

On 1 November, the final phase of the DECIDE abortion telehealth service rollout was completed. As reported in Bulletin 44, DECIDE is a free nationwide initiative aiming to improve access to sexual health practitioner advice and, if required, access to early medical abortion for people within the first ten weeks of pregnancy.

New ACE inhibitor available in December: ramipril

Ramipril (Tryzan), an angiotensin-converting enzyme (ACE) inhibitor, will be funded from 1 December, 2022, without restrictions. Ramipril is indicated for people with hypertension, heart failure, progressive kidney disease and for the prevention of cardiovascular events in people with heart disease. Ramipril will be available in 1.25 mg, 2.5 mg, 5 mg and 10 mg capsules (see dosing information on NZF).

The addition of another funded ACE inhibitor option will be useful for patients transitioning from cilazapril, which is expected to be delisted in mid-2023.

For further information about prescribing ACE inhibitors, see:

N.B. This article will be updated with ramipril prescribing information by 1 December.

Proposal to widen access to meningococcal B vaccine

Pharmac is seeking feedback on a proposal to add meningococcal B vaccine (Bexsero) to the childhood immunisation schedule for infants aged up to 12 months, and for people aged 13 to 25 years entering into their first year of close living (specific criteria listed). Submissions are due by 8th November.

N.B. This consultation also includes a proposal to continue to fund zoster vaccine (Shingrix) for the prevention of shingles. The initial supply of Shingrix was short-term only – the proposal also includes details about widening access to some groups.

COVID-19 information sheet update

With COVID-19 cases numbers starting to rise again, we have updated our patient information sheet on managing at home with COVID-19. This can be downloaded and emailed or printed, or a link sent via text message for the patient or caregivers. Thank you to Dr Kevin Gabriel for getting in touch to request this update and helping us to “road test” the new version.

In Brief: Updates from IMAC

  • You can now contact the Immunisation Advisory Centre (IMAC) with questions about vaccinations via the HealthLink tab on your practice management system; for immediate enquiries call 0800 IMMUNE (0800 466 863)
  • IMAC is hosting webinars on PCV13 (15th November) and monkeypox vaccination (TBC); see website for details

To sign up for emails from IMAC on the latest news on immunisation, click here.

NZF updates for November

Significant changes to the NZF in the November, 2022, release include:

You can also read about any significant changes to the NZFC, here.

Coming soon: Your essential guide to liver function tests

Liver function tests (LFTs) are among the most commonly requested laboratory investigations in primary care. However, as with all other laboratory tests, it is essential that clinicians consider whether LFTs are being requested for the right patient at the right time, and have a clear understanding of how results will be interpreted based on the specific clinical context.

A comprehensive resource on LFTs, along with a spotlight on the key causes of liver disease and a B-QuiCK summary, will be available soon on our website. Keep an eye on your emails for early access.

Paper of the Week: What’s the best age to quit smoking?

As New Zealand works it way towards it’s Smokefree 2025 goal, we may need to come up with some new ways to support the hardest to reach people to stop. It is reported that as of 2020/21 around 9% of people aged over 15 years in New Zealand are daily smokers; this is half the rate reported in 2006/07. Only 1% of 15-17 year-olds and 8% of 18-24 year-olds smoke, compared to 14% and 25% in 2006/07. Smoking rates remain highest among Māori women (24%), but have also reduced considerably.

Providing education about the harms of smoking, and health benefits of quitting, is an important tool in helping motivate people to quit. A recently published study in JAMA Network Open that included over 550,000 adults in the United States found that smokers who quit prior to age 35 years are able to achieve a complete “reversal of risk”. The risk of death associated with smoking was reduced by 90% in those who quit before age 45 years and 66% in those who quit between age 45 to 64 years.

Therefore, to answer the title question, any age before 35 years is the “magic number”. You can tell patients that it’s never too late to quit, but the sooner they do, the more they have to gain.

Thomson B, Emberson J, Lacey B, et al. Association between smoking, smoking cessation and mortality by race, ethnicity and sex among US adults. JAMA Netw Open 2022;5(10):e2231480. doi:10.1001/jamanetworkopen.2022.31480

This Bulletin is supported by the South Link Education Trust

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