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Published: 13th February, 2026
Contents
In case you missed it: Psychostimulant medicine prescribing for ADHD in primary care
Prescribing restrictions and funding criteria have been amended to improve access to psychostimulant treatment for people with ADHD. Vocationally registered general practitioners and nurse practitioners working within their area of practice can now initiate these medicines for adults with ADHD. It is expected that this change will be of most interest to clinicians who have experience in managing patients with ADHD or who intend to undertake training in this area.
Not all primary care clinicians will be involved in diagnosing ADHD, but many will at some stage prescribe psychostimulant treatment. To support prescribers, bpacnz has prepared a brief overview of the prescribing and regulatory changes for psychostimulant medicines for ADHD; a more comprehensive resource on managing patients taking these medicines will be available shortly. This will include information about pharmacokinetics, pre-treatment considerations and investigations, initiation and dose titration, monitoring, switching between formulation types and treatment cessation. It will not cover the diagnosis of ADHD or the use of psychostimulant medicines for other indications such as narcolepsy.
Read the brief overview here.
The Goodfellow Unit recently hosted a webinar on the diagnosis and long-term management of adults with ADHD (as reported in Bulletin 140). If you missed it, a recording of the webinar is available here.
HealthPathways, in conjunction with the RNZCGP, is hosting an upcoming webinar on ADHD in adults on Tuesday, 17th February, from 7 pm. Click here to register.
Rewind: Wrap-up of recent key messages
Key dates and updates on news items from recent editions of Best Practice Bulletin:
- A decision has been made on changes to Special Authority criteria and Hospital Restrictions for the biologic medicines infliximab, etanercept, secukinumab and rituximab (Riximyo and Mabthera) used for a range of autoimmune and inflammatory conditions (as reported in Bulletin 136). The changes will take place from 1st March, 2026, and include simplifying the wording of the Special Authority criteria, increasing Special Authority approval durations, enabling more prescribers to apply for funded access and allowing approvals to be valid without further renewal (unless notified). For further information from Pharmac about this decision, click here.
- Stock of Norimin 28 day (ethinyloestradiol 35 microgram with norethisterone 500 microgram and seven inert tablets; 84 packs) has arrived in the country but may take up to one to two weeks to reach pharmacies. This follows a period of limited supply due to shipment delays (as reported in Bulletin 137).
- The Medical Council of New Zealand has announced that results from Torohia, an online survey for doctors in training, are now available. The survey took place between August and September, 2025 (as reported in Bulletin 128).
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BPAC CareSuite launches
BPAC Clinical Solutions has launched BPAC CareSuite, the new home for its healthcare decision support tools. BPAC CareSuite is expected to improve accessibility to these tools, ease workload pressures on clinicians and support consistent, high-quality clinical advice. BPAC CareSuite is free and can be integrated into Medtech or Indici patient management systems or is accessible via a web browser. Users will initially have access to the ACC Medical Certification dashboard (see next bulletin item), while the Brain Injury Screening Tool (BIST) will be available from early March. The rest of the range of BPAC Clinical Solutions decision support tools will migrate to BPAC CareSuite in the future.
For more information, including a registration form for practices wishing to sign-up, visit: caresuite.co.nz
New ACC Medical Certification dashboard
ACC has announced that the ACC Medical Certification dashboard is now live for providers. The new interactive dashboard displays information on the number of medical certificates issued by a provider over the past two years, the ratio of ‘fully unfit’ and ‘fit for selected work’ certificates, average incapacity durations and return-to-work timeframes. Clinicians can review their data to identify trends and compare over time or with national and regional averages. This dashboard replaces the previous “Your ACC Dashboard” PDF reports (last sent in 2023). ACC expects the new tool to increase transparency when sharing data with primary care. Additional features, including a broader date range and more comparison options, are anticipated to be available from April.
The ACC Medical Certification dashboard is available through BPAC CareSuite (see previous bulletin item). To access the dashboard, visit caresuite.co.nz and complete the registration form. For further information on how to use the dashboard, click here.
Have you seen the bpacnz Recovery at Work clinical education resources? To enhance clinicians’ understanding of medical certification definitions, support decision-making and outline the important elements of Recovery at Work, including rehabilitation services, we developed a Recovery at Work education module. The module consists of:
Pharmac consultation on the Pharmaceutical Schedule
Pharmac is seeking feedback on a consultation regarding the Pharmaceutical Schedule. The Schedule has not undergone significant changes since it was first published in 1994, while there have been substantial changes to Pharmac’s scope and the health sector in that time. Therefore, the Schedule and the systems used to publish it are currently undergoing redevelopment to reorganise and modernise how it is structured and assessed. It is anticipated that a redeveloped Schedule would be published after mid-2027. Proposed changes for the Pharmaceutical Schedule include:
- Consolidating the Community Schedule, Hospital Medicines List and Hospital Medical Devices List into one integrated Schedule
- Basing medicine and related product nomenclature on New Zealand Medicines Terminology
- Providing more comprehensive product details for hospital medicine listings
- Clearly displaying the circumstances in which funding rules apply to medicines with multiple funding pathways
- Having an online-only Pharmaceutical Schedule that can be updated when required (as opposed to the current scheduled releases). N.B. Special Authority forms would still be available as PDFs.
This consultation does not include decision-making (i.e. what medicines are funded) or claims processes (no changes to the Pharmaceutical Transactions Data Specification are anticipated).
Consultation closes 5 pm, Friday, 13th March. This link contains an online form to complete, or feedback can be emailed directly to: consult@pharmac.govt.nz.
Upcoming medicine discontinuations
Pharmac has reminded prescribers about several medicine discontinuations occurring in the coming months. While in most cases, prescribers will not have many patients affected by these medicine discontinuations, patients may require additional support when their treatment is changed if they have been taking the medicine for some time. Information about medicine supply, including discontinuations, is available in the New Zealand Formulary at the top of the individual monograph for any affected medicine and summarised here.
Ketoprofen (Oruvail)
Ketoprofen sustained-release 200 mg capsules (Oruvail), indicated for pain and mild inflammation in rheumatic disease and other musculoskeletal conditions, are being discontinued globally by the supplier (Sanofi). Stock is expected to be exhausted by the end of March, and it will be delisted from the Pharmaceutical Schedule from April. Prescribers should identify patients currently prescribed this medicine and switch them to a suitable alternative funded NSAID prior to March, e.g. ibuprofen, tenoxicam, naproxen.
A patient information sheet about the discontinuation is available here.
Amiloride with furosemide (Frumil)
Amiloride 5 mg with furosemide 40 mg (Frumil) tablets, indicated for congestive heart failure, are being discontinued globally by the supplier (Sanofi) due to low sales (as reported in Bulletin 138). Stock is expected to be exhausted by the end of February; a delisting date is yet to be announced. Any patients who are still prescribed this medicine will need to be switched to an alternative as soon as possible. See NZF for information on available diuretics. N.B. Amiloride 5 mg tablets are funded but not approved by Medsafe and would need to be prescribed for supply under Section 29.
A patient information sheet about the discontinuation is available here.
Selected insulin products
Pharmac has advised that some insulin products from Eli Lilly and Novo Nordisk are being discontinued in 2026. The affected products are:
- Eli Lilly
- Humulin R (insulin neutral) 10 mL vials from the end of March
- Humalog (insulin lispro), Humulin NPH (insulin isophane) and Humulin 30/70 (insulin isophane with insulin neutral) 10 mL vials from the end of June
- Novo Nordisk
- Actrapid (insulin neutral) and Protaphane (insulin isophane) penfills by the end of 2026
The 3 mL cartridge presentations of the Eli Lilly products will remain available for use in HumaPen insulin pens while Actrapid and Protaphane will remain available in 10 mL vials. Prescribers should identify patients currently prescribed affected presentations and begin transitioning them to a suitable alternative.
For further information on prescribing insulin, see:
More treatments for trauma/medical emergencies and palliative care funded in the community
Pharmac has announced the decision to fund a range of medicines for trauma and medical emergencies and ketamine for palliative care in the community, following consultation.
From 1st March, 2026, the following medicines will be funded on PSO if endorsed for a Primary Response in Medical Emergencies (PRIME) service:
- Droperiodol
- Glucose (5% and 10%)
- Ketamine
- Methoxyflurane
- Tranexamic acid
- Enoxaparin
In addition:
- Ketamine will also be funded on prescription, PSO and Bulk Supply Order (BSO) if endorsed to treat intractable pain in patients receiving palliative care in the community. N.B. Ketamine must be used under Section 25.
- Tranexamic acid will also be funded on PSO if endorsed for the treatment of post-partum haemorrhage
This decision has been made to assist in removing barriers to accessing emergency treatments for people who live in rural and remote areas, as well as supporting people to receive palliative care at home or in another community setting.
Updated pre-hospital community sepsis pathways
The Health Quality and Safety Commission, Te Tāhū Hauora, has published updated pre-hospital sepsis pathways for use in the community. The tools were developed in conjunction with Sepsis Trust NZ, HealthPathways and the national multidisciplinary Sepsis Technical Advisory Group. They are intended for general practitioners, nurse practitioners, nurses, midwives, paramedics and anyone working in community health to enable early recognition of sepsis and timely management. There are three separate pathways for:
These resources will also be available on local HealthPathways sites.
Measles outbreak declared over but remain vigilant
Te Whatu Ora, Health New Zealand, has announced that the measles outbreak that first began in September, 2025, has now ended. A total of 48 cases were connected to the outbreak. New Zealand remains at high risk of future measles outbreaks; therefore, healthcare professionals should remain alert for symptoms and signs of measles, particularly in patients who are not vaccinated or are immunocompromised and have a history of recent overseas travel. N.B. A measles case was reported in Tauranga in January, however, it is not connected to the recent national outbreak.
Is your patient population up to date with MMR vaccination? Opportunistically check whether patients have received both doses of the MMR vaccine and offer vaccination where appropriate. Also ensure that patients with upcoming international travel or those planning pregnancy are fully vaccinated with MMR. See the Immunisation Handbook for details.
Upcoming IMAC webinar: Influenza, COVID-19 and RSV vaccinations
The Immunisation Advisory Centre (IMAC) is hosting an upcoming webinar in conjunction with Health New Zealand on preparing for the winter respiratory virus season. This free webinar will cover the 2026 flu programme, the new Comirnaty LP.8.1 COVID-19 vaccine and RSV vaccine (not funded), as well as practical issues, e.g. post-vaccination wait times. The webinar will be held on Tuesday, 10th March, from 5 pm. Click here to register.
In a recent email to the sector, IMAC has announced that the transition to the 30 microgram Comirnaty LP.8.1 vaccine for people aged 12 years and over will occur from Monday, 2nd March, Stock can be ordered from mid-February.
NZF updates for February + ADHD medicines practice highlight
Significant changes to the NZF in the February, 2026, release include:
You can read about all the changes in the February release, here. Also read about any significant changes to the NZF for Children (NZFC), here.
NZF practice highlight: Changes to prescribing of ADHD medicines
This month, the NZF team highlight key points from the updated therapeutic notes on medicines used for ADHD, following the recent changes that were made to the prescribing of these medicines:
- Psychostimulant medicines are the first-line pharmacological treatment for adults with ADHD
- Start at a low dose and titrate up, with regular review
- There is substantial inter-person variability in dosing requirements, treatment response and adverse effects
- Pharmacokinetic profile, e.g. drug-release, duration of effect, varies with formulation. Choice of formulation can be guided by patient preferences. Click here for a comparison table of methylphenidate preparations.
- Changing to an alternative psychostimulant medicine may be required if the patient does not respond to one after an adequate trial
- When switching between differing formulation types/medicines, close monitoring is required for treatment response and adverse effects. Release profiles (onset, peak, duration) differ substantially. Click here for a table on approximate dose equivalence between methylphenidate preparations.
- There is no established dose equivalence between methylphenidate and amfetamines, or between lisdexamfetamine and dexamfetamine. Therefore, independent dose titration is recommended when switching between psychostimulant medicines.
Paper of the Week: Deprescribing guidelines for older adults
Extended prescribing has been a focus for primary care to start the year. The fundamental message has been that prescribing medicines for longer than three months will only be suitable (and safe) for certain groups of patients. In many cases, extended prescribing will not be appropriate for older people due to frailty, co-morbid conditions, polypharmacy and medicine regimen complexity. Older adults are often at higher risk for adverse effects from medicines due to age-related physiological changes, e.g. increased blood brain barrier permeability, reduced hepatic or renal function, and multiple health conditions that require different medicines for management. Therefore, instead of considering extended prescribing, primary care clinicians may want to pause and look the other way. Consider whether medicines prescribed to older patients are appropriate, necessary and whether any can be stopped.
In September last year, the University of Western Australia published a new clinical guideline for deprescribing medicines in older people. This guideline has been endorsed by the Australian and New Zealand Society for Geriatric Medicine and Royal Australian College of General Practitioners. It focuses on deprescribing in patients aged 65 years and over, but some recommendations and advice may be applicable to other patient groups. Deprescribing information on more than 30 medicine classes is included, however, the guide does not contain medicines used for short-term treatment of acute illness, those available over the counter or complementary or alternative medicines. The shared decision-making aspect of deprescribing is reinforced throughout the guideline; ensure the patient (and their caregivers or family/whānau if appropriate) is part of any discussions regarding changes to their medicine regimen.
What medicine(s) do you commonly consider deprescribing? Are there any specific patient factors, e.g. age, frailty, that would prompt you to consider deprescribing? What resources do you use when deciding whether deprescribing is an appropriate option for a patient?
Read more
General principles of deprescribing
- Deprescribing is suggested if the medicine:
- Has no clear indication, is contraindicated or contributes to an inappropriate prescribing cascade
- Is implicated in adverse effects (or interactions) that outweigh the benefits of prescribing
- Was previously prescribed for specific symptoms, and these have resolved and are unlikely to return
- Was prescribed for prevention of a specific outcome, but the benefits are uncertain or may not be realised based on the patient’s current clinical situation
- Develop and follow an individual deprescribing plan if a decision is made to withdraw a medicine
- Tapering is often required, particularly if the medicine is expected to cause withdrawal effects or recurrence of the condition is possible
- Deprescribe one medicine at a time in most cases. Multiple medicines, i.e. up to three, could be deprescribed simultaneously if the risk of adverse effects are low these effects can clearly be attributed to one medicine.
Deprescribing specific medicine classes
- The medicines contained in the guideline include those commonly prescribed (in Australia) to older adults, or those where specific evidence is available to guide deprescribing decisions. Specific deprescribing advice includes:
- Anticoagulants may be withdrawn if the risk of major/recurrent bleeding outweighs the benefit of prevention of ischaemic stroke or thromboembolism
- Antidepressants could be withdrawn from patients who are coping well (i.e. symptomatic remission or clinical stability) for 6 – 12 months with uninterrupted treatment
- Antihypertensives could be withdrawn in patients aged over 80 years with a systolic blood pressure < 150 mmHg (or < 140 mmHg in patients aged 75 – 79 years) and diastolic blood pressure < 90 mmHg who experience hypotension, recurrent falls, determined to have moderate-to-severe frailty assessed using validated tools or life expectancy < 3 years
- Proton-pump inhibitors (PPIs) could be withdrawn if the original indication was short-term, e.g. up to eight weeks for gastro-oesophageal reflux disease, up to 12 weeks for peptic ulcer disease, two weeks for Helicobacter pylori eradication
Follow-up during the deprescribing process
- Follow-up with patients is suggested every two weeks during deprescribing and for at least four weeks after the medicine is discontinued. Ongoing monthly monitoring for the first three months, followed by six-monthly monitoring is then recommended.
- Monitoring interval frequency may differ depending on what medicine is being deprescribed, e.g. multivitamins vs antihypertensives. More specific information is provided in individual medicine sections.
- Provide patients with clear guidance on when to seek medical attention if adverse effects occur
- Consider increasing the monitoring frequency at any point if the patient’s clinical status changes, e.g. acute illness
- Although not specified in the guide, clinical judgement will determine the appropriate method of follow-ups, e.g. in-person or via phone check-in
- If an attempt to deprescribe a medicine is not successful, consider the following options:
- Continue with a tapered dose but delay further dose reduction until the patient has stabilised. The duration of this monitoring period should be determined using shared decision-making.
- Continue at the current tapered dose but do not reduce the dose further
- Restart the medicine at approximately 75% of the previously tolerated dose
- Restart the medicine at the originally prescribed dose
Quek HW, Reus Perello X, Lee K, et al. Deprescribing in older people: a clinical practice guideline. Perth: The University of Western Australia 2025. doi:10.26182/xtsx-3r73.
Anticholinergic medicines are often associated with adverse effects in older adults. For further information on deprescribing anticholinergic medicines, see: https://bpac.org.nz/2024/anticholinergic.aspx
This Bulletin is supported by the South Link Education Trust
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