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Adverse drug reactions and interactions

Anticholinergic burden in older people

Older people, particularly those who are frail and with multiple morbidities, are most susceptible to the cumulative effects... View Article

March 2024

Limiting the use of quinolone antibiotics

Quinolones (e.g. ciprofloxacin, norfloxacin) are associated with increasing antimicrobial resistance and rare, but potentially... View Article

February 2021

The nocebo effect: what is it, why is it important and how can it be reduced?

The nocebo effect describes adverse symptoms induced independently of the active component of a treatment. This occurs due to... View Article

August 2019

Avoiding the triple whammy in primary care: ACE inhibitor/ARB + diuretic + NSAID

Angiotensin converting enzyme (ACE) inhibitors, angiotensin-II receptor blockers (ARBs), diuretics and nonsteroidal anti-inflammatory... View Article

May 2018

Immune checkpoint inhibitors: a new cancer treatment

Immune checkpoint inhibitors, such as pembrolizumab (Keytruda), are new cancer treatments which are associated with a wide range... View Article

March 2018

Clozapine: safe prescribing

In 2014, bpacnz published an article on the safer prescribing of clozapine. Since this time, a number of fatalities, along with... View Article

September 2017

Proton pump inhibitors and the risk of acute kidney injury

Proton pump inhibitors (PPIs) are among the most prescribed medicines in New Zealand. They are clinically effective and are widely... View Article

August 2016

Alcohol misuse: how to help patients in primary care

This article has been superseded by: Assessment and management of alcohol misuse by primary care bpacNZ, November 2018 If... View Article

May 2016

Using the NZF Interactions Checker

The New Zealand Formulary (NZF) contains a function that identifies potential drug interactions and their clinical significance.... View Article

December 2015

Upfront: An avoidable death: the importance of communication in clinical care

The following treatment injury case study was prepared by the Accident Compensation Corporation (ACC) in conjunction with the... View Article

August 2015

Do probiotics provide effective and safe protection against antibiotic-associated adverse effects?

Sales of probiotic products in the community generate billions of dollars worldwide, yet many of the health claims made by the... View Article

June 2015

Safer prescribing of high-risk medicines - Methotrexate: potentially fatal in overdose

Low-dose methotrexate is commonly used in the treatment of patients with rheumatoid arthritis and other rheumatologic diseases,... View Article

October 2014

Safer prescribing of high-risk medicines: Colchicine – extremely toxic in overdose

Updated 2021Colchicine is a plant-based alkaloid, extracted from Colchicum autumnale (autumn crocus, meadow saffron) and Gloriosa... View Article

September 2014

Safer prescribing of high-risk medicines: Clozapine

Pharmacological treatment is an integral part of the practice of medicine, and is one of the most significant factors in improving... View Article

July 2014

Hazardous substances series: Pyrethroid toxicity and its management

Contributed by Dr Michael Beasley and Dr Wayne Temple, National Poisons Centre View Article

December 2013

Long-term Use of Corticosteroids: Think about Bone Health

Bone density loss leading to osteoporosis is a risk for patients taking long-term corticosteroids. Bone health is important in... View Article

November 2013

Non-steroidal anti-inflammatory drugs (NSAIDs): Making safer treatment choices

Non-steroidal anti-inflammatory drugs (NSAIDs) are successfully used to treat a wide range of painful conditions. However, NSAIDs... View Article

October 2013

Ticagrelor – out with the old, in with the new?

Ticagrelor (Brilinta) is a new oral antiplatelet medicine, which has been available, fully subsidised, with Special Authority,... View Article

August 2013

Statins and the risk of acute kidney injury

THERE HAVE BEEN RECENT REPORTS in the literature associating the use of statins with acute kidney injury (AKI). A study by Hippisley-Cox... View Article

April 2013

Hypomagnesaemia with proton pump inhibitors

IN DECEMBER, 2012 MEDSAFE published a warning on the risk of hypomagnesaemia for people taking any proton pump inhibitor (PPI).... View Article

April 2013

H1N1 influenza vaccination and the risk of childhood narcolepsy

IN MARCH, 2012 A SIGNIFICANT INCREASE in the rate of childhood narcolepsy associated with the influenza vaccine Pandemrix (GlaxoSmithKline)... View Article

April 2013

Dabigatran revisited

Dabigatran has been available for general practitioners to prescribe since July, 2011. Dabigatran is indicated for prevention... View Article

February 2013

Appropriate use of sulfonamides

What are sulfonamides and how do they work? | Prescribing co-trimoxazole | Adverse effects of co-trimoxazole | Medicine interactions... View Article

December 2012

Appropriate use of tetracyclines

What are tetracyclines and how do they work? | Which infections should tetracyclines be used for? | First-line indications for... View Article

October 2012

Medicines interactions: using the New Zealand Formulary

How to interpret Stockley's Interaction Alerts How to use the interactions checker Relative importance of interactions Additional... View Article

September 2012

The appropriate use of macrolides

Macrolides are a class of antibiotic that includes erythromycin, roxithromycin, azithromycin and clarithromycin. First-line indications... View Article

May 2012

Prescribing citalopram safely: an update

Evidence of adverse cardiac effects associated with citalopram has prompted a reduction in the recommended maximum daily dose... View Article

February 2012

News in brief: Maternity referral guidelines & Simvastatin

• New maternity referral guidelines released
• Simvastatin: risk associated with high doses
View Article

September 2011

News in brief: Dabigatran; Antibiotics and COC; Prescription kitchen

Dabigatran to be listed | Most broad spectrum antibiotics do not affect the combined oral contraceptive | Prescription kitchen View Article

June 2011

Quinolone antibiotics - limit use

Quinolones are associated with increasing antimicrobial resistance. Their use needs to be reserved for specific indications involving... View Article

April 2011

Methotrexate prescribing errors can be fatal

When used and monitored correctly methotrexate can be an effective and safe treatment, however, if an error occurs and it is taken... View Article

February 2011

Snippets: Jadelle & Sibutramine

This article has been archived. If you would like access to the original article please contact: editor@bpac.org.nz View Article

November 2010

The warfarin dilemma

Evidence suggests that warfarin is under utilised in older people. The dilemma is that in older people with atrial fibrillation,... View Article

October 2010

Snippets: Iodine supplements Zoledronic acid & Atorvastatin

This article has been archived. If you would like access to the original article please contact: editor@bpac.org.nz View Article

August 2010

Prescribing issues associated with anticonvulsant medications for epilepsy

The goal of successful pharmacological treatment in epilepsy is the complete control of seizures, however for some people this... View Article

November 2009

Low molecular weight heparin use in primary care

Enoxaparin (Clexane) is a low molecular weight heparin used in the treatment of acute coronary syndromes and in the treatment... View Article

November 2009

Oxycodone: place in therapy

Oxycodone is a strong opiod and is a second line option (after Morphine) for use at step three on the WHO analgesic ladder. It... View Article

November 2009

TNF inhibitors - an update

Tumour necrosis factor (TNF) inhibitors are used in the treatment of rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis,... View Article

November 2009

Practice tips: PPIs and Paraffin

All about PPIs, Fire hazard with paraffin View Article

September 2009

Pharmacological Management of Depression in Adults

All antidepressant drugs are approximately equal in effectiveness, although individual patient response may vary markedly.10 View Article

July 2009

Monitoring of generic medicines and brand changes

Dr Michael Tatley of CARM advises on how brand changes are monitored. View Article

July 2009

Adverse reaction reporting tool

On April 1 2009, the Minister of Health launched a new electronic adverse reaction reporting tool in New Zealand. The tool is... View Article

June 2009

Fluoroquinolone-associated tendon disorders

The use of oral fluoroquinolones is associated with increased risk of tendinitis and tendon ruptures. View Article

June 2009

Upfront: The isotretinoin debate

There are two major safety concerns with isotretinoin :
• It is teratogenic at all therapeutic doses and durations of exposure...
View Article

April 2009

The role of antiplatelet agents

Antiplatelet drugs including aspirin, clopidogrel and dipyrimadole, reduce the incidence of cardiovascular events by about 20-25%... View Article

February 2009

Anticholinergics for COPD

Two recent studies have raised concern that the use of ipratropium and tiotropium for COPD is associated with an increased risk... View Article

December 2008

WHO Analgesic Ladder: Methadone - safe and effective use for chronic pain

Methadone is a strong opioid that may be suitable for people whose pain is uncontrolled with, or who are unable to tolerate, morphine.... View Article

December 2008

Rheumatoid arthritis - monitoring of DMARDs

Most people with rheumatoid arthritis require early treatment with disease modifying-anti-rheumatic drug (DMARD) therapy to control... View Article

October 2008

Medication-overuse headache: when the cure becomes the cause

Medication-overuse headache is a complex disorder best described as an interaction between a therapeutic agent used excessively... View Article

September 2008

Clozapine: A reminder about safe and effective use

Although clozapine is a specialist prescribed drug, GPs still need to be aware of potential problems associated with its use.... View Article

June 2008

Snippets: Anticonvulsants & Salbutamol

This article has been archived. If you would like access to the original article please contact: editor@bpac.org.nz View Article

June 2008

Snippets: Varenicline & Smoking

Varenicline and suicidal behaviour. Wider access to quit cards.The lung age of smokers. View Article

May 2008

Combined oral contraceptives: Issues for current users

Oral contraceptives are used by 147,000 New Zealand women. This article offers guidance for managing their use in the presence... View Article

April 2008

Snippets: NSAIDs dextropropoxyphene and antibiotic resistance

Drug information of topical interest View Article

February 2008

Dear Dave

• Breakthrough Bleeding
• Camphor in Pregnancy
View Article

December 2007

Snippets: Drug information of topical interest

• Calcium Supplementation and the risk of myocardial infarction
• Use of eGFR for drug dose adjustment
• Compulsive gambling...
View Article

December 2007

Dear Dave

Does the "seven day rule" still apply with the concomitant use of combined oral contraceptives and all antibiotics? Serotonin... View Article

September 2007

Lumiracoxib linked to deaths in Australia

Medsafe have just announced that approval for lumiracoxib (Prexige) 400 mg tablets has been revoked in New Zealand. This follows... View Article

September 2007

Dear Dave

Can Sumatriptan be used safely with SSRIs? Can you ever use beta-blockers in someone with a history of Asthma? View Article

August 2007

CARM reports: Acute Renal Failure

In the five years from 2002 to 2006 CARM (Centre for Adverse Reactions Monitoring) received 72 reports of acute renal failure... View Article

June 2007

Dear Dave

What is the significance of the warning between ACE inhibitors and allopurinol. View Article

June 2007

Clozapine - Safe and Effective Use

Clozapine is the gold-standard treatment for people with schizophrenia who are unresponsive to, or intolerant of, other antipsychotics.... View Article

April 2007

Dear Dave

Is there an association between the use of the combined oral contraceptive and Vitamin B12 deficiency View Article

April 2007

Interactions with Warfarin

Warfarin has the potential to interact with numerous drugs resulting in significant morbidity and potentially fatal bleeds. Loss... View Article

April 2007

The CYP450 System

An overview of the CYP450 system with particular reference to the metabolism of antidepressant drugs. View Article

March 2007

Drug Interactions with Antidepressants

Table of important drug interactions with antidepressant medications. View Article

March 2007

CARM Reports; Serotonin Syndrome and Neuroleptic Malignant Syndrome

Covers the symptoms and causes of Serotonin Syndrome and Neuroleptic Malignant Syndrome View Article

February 2007

Dear Dave

Can smoking cessation affect the dose of antipsychotics?Do statins cause nightmares?How important is it to give simvastatin at... View Article

February 2007

Lithium in General Practice

In this article we provide an overview and guidance on the management of patients taking lithium. View Article

February 2007

Amiodarone:- safety issues

Reducing adverse events in patients taking amiodarone. View Article

December 2006

Dear Dave

SSRIs can increase the risk of bleeding disorders, especially if taken with an NSAID. View Article

December 2006

TCAs are useful for depression and neuropathic pain

Tricyclic antidepressants (TCAs) are an effective alternative to selective serotonin re-uptake inhibitors (SSRIs) in the treatment... View Article

December 2006

Ten minute audit

Identifies people under the age of 18 years on paroxetine to enable checks for suicidal and aggressive behaviour View Article

October 2006

NSAIDs and coxibs

Cardiovascular risk associated with NSAIDs and coxibsNSAIDs in the treatment of soft tissue injuries View Article

October 2006

Polypharmacy at the Primary-Secondary interface

Polypharmacy due to multiple physician involvement in patient care increases the risk of serious adverse drug event. View Article

October 2006

Appropriate use of cephalosporins

There are very few indications for the use of cephalosporins as first-line antibiotic treatment. Ceftriaxone is used for the treatment... View Article

December 2011