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Published: 5th June, 2026
Contents
What’s trending at bpacnz this week?
The bpacnz website is home to thousands of resources designed for primary healthcare professionals in New Zealand. Every week, in practices, workplaces, universities and homes all around the country, hundreds of these articles are read and the chosen topics can often tell us a story about what’s currently important in health.
The most popular articles on the bpacnz website this week include Urinary tract infections (UTIs) – an overview of lower UTI management in adults, covering the diagnostic work-up and treatment of uncomplicated UTIs as well as options for recurrent UTIs; Oral contraceptives: selecting a pill, part of the Contraception series, in which you can find information and prescribing guidance for all available contraception options; and Hypertension in adults: the silent killer, where you can update yourself on the latest guidelines for treating this commonly seen condition in primary care: if your patients are not on dual antihypertensive treatment yet, consider if they should be.
In a continuation of our focus on chronic kidney disease in 2026, we have recently published a clinical audit and peer group discussion to complement the main resource: Chronic kidney disease – the canary in the coal mine. Stay tuned for an upcoming opportunity to contribute to a panel discussion with the experts.
Find the answers to your clinical questions here, or just stay a while to browse and learn something new.
Spotlight on: Getting prepared for winter
Winter has arrived, bringing cooler temperatures, shorter days and the usual increase in seasonal illnesses seen in primary care. bpacnz has many winter illness resources available for primary care clinicians on our website, including an overview of managing community-acquired pneumonia, identifying the risk of serious illness in young children with fever, cough medicines: do they make a difference?, and CPD activities such as a peer group discussion on managing winter illnesses in primary care, and a clinical audit on managing winter illnesses without antibiotics, which is also endorsed by the Royal New Zealand College of Urgent Care.
View all of our resources, here, or you can browse by category, e.g. infections, respiratory conditions.
Patient information sheets are also available, and can be downloaded and printed, or the link sent to patients:
Rewind: Wrap-up of recent key messages
Key dates and updates on news items from recent editions of Best Practice Bulletin:
- Pharmac has extended the closing date for the consultation on amendments to Special Authority criteria and widening access to type 2 diabetes medicines (empagliflozin, empagliflozin + metformin, dulaglutide and liraglutide) to Thursday, 11th June (as reported in Bulletin 148)
- Ongoing supply issues have affected availability of mometasone furoate (Elocon) products (last reported in Bulletin 146). Stock of both sizes of Elocon cream and ointment products are now available. Re-supply of Elocon lotion is expected in July.
- Supply issues affecting colestyramine (Mylan) remain ongoing (as reported in Bulletin 147). An alternative brand, Questran Light (Neon), was listed on the Pharmaceutical Schedule on 1st June (Section 29).
- The monitoring period for the Medsafe Alert Communication relating to atomoxetine and the possible risk of gynaecomastia closes Monday, 15th June. See Bulletin 140 for further information.
- Ketamine (Ketalar; 200 mg/2 mL) was recently funded if endorsed to treat intractable pain in patients receiving palliative care (unapproved indication). While most primary care clinicians will not prescribe ketamine, many will be interested to read about this medicine, how it is used in a community setting and why it has recently been funded; see Bulletin 148.
Diphtheria outbreak in Australia: Current risk to New Zealand is low
In early May, Health New Zealand, Te Whatu Ora, released a public health advisory statement in response to the ongoing diphtheria outbreak involving several Australian states. There have been over 245 diphtheria cases notified in Australia as of 25th May, 2026, and one death where diphtheria was the probable cause. The current risk to New Zealand is considered low, however, there is an ongoing risk of cases related to overseas travel.
Healthcare professionals should be alert for symptoms and signs of diphtheria (e.g. severe acute respiratory infection, non-healing skin ulcers) in patients with a history of recent overseas travel. All suspected cases of diphtheria must be notified to the local Medical Officer of Health. Do not wait for laboratory confirmation before notifying.
Vaccination is the most effective way to prevent diphtheria. Opportunistically check patients are up to date with diphtheria vaccinations (in DTaP and Tdap) as part of the National Immunisation Schedule (including booster doses where indicated), and offer vaccination where appropriate.
Read more about diphtheria
Diphtheria is a rare but serious bacterial infection caused by strains of Corynebacterium diphtheriae that usually affect the throat and nose (respiratory diphtheria), but can also affect the skin (cutaneous diphtheria). Transmission occurs via close contact, respiratory droplets or contaminated objects. While many cases are mild, some people can experience serious complications (usually due to the toxins released from the bacteria) including myocarditis, paralysis and kidney failure; the case fatality rate is 5 – 10%.
A small number of diphtheria cases have been notified in New Zealand over the past few decades; the most recent cases of respiratory diphtheria occurred in 1998. Cases of cutaneous diphtheria have occasionally been reported in New Zealand since then, related to overseas travel.
For further information about diphtheria, see: https://immune.org.nz/diseases/diphtheria
A short episode from The Good GP, an Australian podcast series, covering the current outbreak in northern Australia is available here
Medicine news
The following news relating to medicine supply has recently been announced. These items are selected based on their relevance to primary care and where issues for patients are anticipated, e.g. no alternative medicine available or changing to the alternative presents issues. Information about medicine supply is available in the New Zealand Formulary at the top of the individual monograph for any affected medicine and summarised here.
Supply issue affecting risperidone 0.5 mg and 2 mg tablets
There is a supply issue affecting stock of risperidone 0.5 mg and 2 mg tablets (Teva), an antipsychotic, due to manufacturing issues. A re-supply date is yet to be announced; other presentations are not currently affected.
An alternative brand (Risperidone Sandoz) has been listed on the Pharmaceutical Schedule since 1st June; however, it is not approved by Medsafe, therefore will need to be prescribed for supply under Section 29A of the Medicines Act. Reassure patients that there has been no change to the active ingredient, but the tablets and packaging of Risperidone Sandoz will look different to Teva.
Oestradiol valerate 2 mg tablet supply issue
Oestradiol valerate 2 mg tablets (Progynova), packaged for New Zealand, may be unavailable until at least July. An Australian-packaged version of Progynova has been listed on the Pharmaceutical Schedule since 1st June. The box is similar in appearance but comes in a smaller pack size (56 instead of 84) and includes Australian contact details.
Limited stock of TruSteel infusion sets
There is a global supply issue affecting all TruSteel insulin pump infusion sets, due to difficulties with the manufacturer sourcing a component. The supply issue is expected to continue for the remainder of the year. Dispensing of TruSteel infusion sets has been temporarily switched to monthly.
Prescribers are asked to consider switching patients to the AutoSoft infusion sets (a new prescription will be required) where clinically appropriate, so that TruSteel can be reserved for those who need it. AutoSoft infusion sets are not suitable for all patients, e.g. those with Teflon sensitivity, and they have different application and priming requirements to TruSteel. Transition guidance is available here.
Latest edition of Prescriber Update released
The June edition of Prescriber Update has been published. Particular items of interest for primary care include:
Adverse effects from inappropriate topical corticosteroid use
From mid-March, 2028, products containing a topical corticosteroid for treating inflammatory skin conditions must have information about potency on the container/packaging (as reported in Bulletin 143). The risk of serious adverse effects, such as skin atrophy and adrenal suppression, with topical corticosteroids is increased with inappropriate use, e.g. prolonged or frequent use, higher-potency products on sensitive areas.
To reduce the risk of adverse effects with topical corticosteroids, prescribe the lowest effective potency, and provide patients with clear application instructions, including the quantity (fingertip unit measurements can be helpful), frequency and the duration of use. If prescribing more than one topical corticosteroid, explain the different potencies and where each product should be applied to reduce the risk of inappropriate use. Read the full article here.
Endocrine, hepatobiliary and gastrointestinal effects linked to opioids
Drowsiness, respiratory depression and constipation are established adverse effects of opioids. Medsafe is now advising clinicians, that in addition to this, be aware that use of opioids for longer than one month can lead to suppression of hypothalamic-pituitary axes due to stimulation of opioid receptors in the hypothalamus. This can result in effects such as hypogonadism, adrenal insufficiency and hyperprolactinemia. Patients taking higher doses of opioids, taking them for longer periods or prescribed long-acting formulations are at greater risk of these effects. Opioids have also been linked to an increased risk of biliary tract symptoms and pancreatitis (particularly morphine) and oesophageal dysfunction, including dysphagia, heartburn, regurgitation and non-cardiac chest pain.
Consider opioids as a possible cause of endocrine, hepatobiliary or other gastrointestinal effects in patients taking them long term, particularly at higher doses. Dose reduction or discontinuation may be required. Read the full article here.
A focus on insulin autoimmune syndrome
Insulin autoimmune syndrome (IAS) is a rare condition that is characterised by recurrent episodes of hypoglycaemia, elevated serum insulin and the presence of insulin autoantibodies. It usually occurs in people who do not require exogenous insulin. Insulin autoantibodies bind to circulating insulin, forming large complexes that initially reduce the action of insulin. The autoantibodies have a low affinity for insulin; as insulin is not tightly bound, it can dissociate unpredictably causing recurrent hypoglycaemia.
Medicines such as captopril, carbimazole and clopidogrel, that contain a sulfhydryl (-SH) or thiol (R-SH) group, are a trigger for the condition in around half of cases; IAS was recently added as a warning to the captopril data sheet. Other triggers include viral infections (e.g. measles, varicella zoster) and haematological conditions (e.g. multiple myeloma). A genetic predisposition is also believed to be involved.
Consider discontinuing the medicine if IAS is suspected, and provide the patient with supportive management to reduce the risk of hypoglycaemia. IAS is usually self-limiting and insulin autoantibodies tend to resolve within a few months. Read the full article here.
Adverse reactions reported with ashwagandha-containing products
Medsafe is reminding clinicians about adverse reactions (e.g. severe gastrointestinal symptoms and liver-related effects) associated with ashwagandha-containing complementary and alternative medicines (CAMs), following reports to the New Zealand Pharmacovigilance Database.
If a patient presents with unexplained symptoms, ask about use of any CAMs. Patients should be advised to stop use if they are experiencing adverse effects; suspected reactions can be reported to the Centre for Adverse Reactions Monitoring. Patients should also be reminded that products purchased via unverified websites, including social media, may contain undisclosed ingredients, and CAMs do not undergo regulatory assessment in New Zealand. Read the full article here.
Read the full edition of Prescriber Update here
Medsafe Alert Communication about use of unapproved peptide products
Medsafe has published an Alert Communication aimed at consumers about the health and legal risks associated with use of unapproved peptide products and selective androgen-receptor modulators (SARMs). This communication comes following an increase in the importation, sale and seizure of these products in New Zealand, which are being promoted overseas and marketed as having cosmetic, performance or wellness benefits.
Read more
These peptide or SARM products, such as BPC‑157, CJC-1295, Kisspeptin and melanotan II, have not been assessed for quality, safety or efficacy by Medsafe and are therefore unapproved. Many of these products would be classified as prescription medicines under the Medicines Act 1981, meaning that it is unlawful to import, sell or possess them without appropriate authorisation. Medsafe has specifically warned about retatrutide, a potential medicine not yet approved by any trusted medicines regulator (currently only available through overseas clinical trials). International reports have linked illicit retatrutide to fatal overdose, contamination and other adverse effects, such as severe neurological symptoms and hair loss.
Unapproved peptide products may be manufactured in non-sterile conditions, have undisclosed ingredients and lack appropriate dosing information. This means there is a risk of infection, especially if injected, as well as other unknown adverse effects and medicine interactions.
People who have purchased these products should be advised not to use them and to dispose of them safely by taking them to a community pharmacy or drug-checking service. They should also be advised to seek medical attention if they feel unwell after using them. Patients experiencing adverse effects with these products should be managed as appropriate depending on the symptoms and signs they present with, e.g. infection, injection site reactions, gastrointestinal disturbance. Medsafe advises people using these products to report any adverse effects to the Centre for Adverse Reactions Monitoring.
A short episode from The Good GP, an Australian podcast series, on performance and image enhancing peptides is available here
Coeliac Awareness Week coming up
Coeliac Awareness Week runs from Monday, 15th June, to Sunday, 21st June. The theme for this year is “Together we can thrive gluten free.” Coeliac disease affects around 1 in 100 adults. However, it is estimated that 50 – 80% of people with coeliac disease in Western countries are undiagnosed. Not all people with coeliac disease present with gastrointestinal symptoms, e.g. diarrhoea, constipation, nausea, vomiting, bloating and cramping. Other features such as faltering growth, short stature and delayed puberty in children, recurrent miscarriage, muscle and joint pain, headache or skin conditions, e.g. dermatitis herpetiformis, may not be immediately attributed to coeliac disease leading to delayed diagnosis. Some people are asymptomatic but may have nutritional deficiencies as a result of malabsorption caused by underlying intestinal damage.
Coeliac Awareness Week is an opportunity for clinicians to refresh their knowledge about the condition and to consider whether they are testing appropriately. In addition to investigating a patient with possible symptoms of coeliac disease, testing is also recommended in those at increased risk, e.g. strong family history or an associated condition such as type 1 diabetes, autoimmune thyroid disease or unexplained infertility.
Check in with your patients diagnosed with coeliac disease: how they are managing with a gluten-free diet? Do they have any new or persistent symptoms that require further investigation?
For further information on the diagnosis and management of coeliac disease, see: https://bpac.org.nz/2022/coeliac.aspx. A checklist, developed by Coeliac New Zealand, for primary care clinicians on managing patients with coeliac disease is also available here.
Fees for IMAC vaccinator training courses to be reintroduced
IMAC has announced that from 1st July, 2026, registration fees for many vaccinator training courses will be re-introduced, as temporary funding from Health New Zealand has ended. Foundation courses, including Flexible learning vaccinator foundation, Vaccinating Health Worker (VHW) Stage 1 and Maternal Immunisation Essentials for Midwives, will remain free. View the fee schedule for IMAC vaccinator training courses, here.
GP CME Conference Rotorua next week
If you are attending the GP CME conference in Rotorua at the end of next week (11th – 14th June), be sure to talk to our colleagues at the South Link Education Trust stand (75 – 76). The South Link Education Trust is returning as the Diamond Sponsor of the GP CME conferences, and is home to South Link Health, BPAC Clinical Solutions, InPractice, bpacnz Publications and the New Zealand Formulary.
NZF updates for June + practice highlight on prescribing errors
Significant changes to the NZF in the June, 2026, release include:
- General revision of contraindications and cautions for tenecteplase and alteplase. Gentamicin hypersensitivity has been removed as a contraindication for alteplase.
- General update to the therapeutic notes for:
- Chloroquine phosphate (Section 29, unapproved medicine) is no longer indicated for rheumatoid arthritis or systemic and discoid lupus erythematosus
- Indications, dosing regimen and patient advice updated for ciclopirox (RejuveNail; pharmacy-only)
- Concomitant corticosteroids (including inhaled) – dose of corticosteroid may need increasing has been added a caution to mifepristone. Patient advice has also been added to the monograph.
- Minor wording changes to the breast-feeding advice for tramadol
You can read about all the changes in the June release, here. Also read about any significant changes to the NZF for Children (NZFC), here.
NZF practice highlight: Preventing errors in prescribing
This month, the NZF team highlight guidance from the Medical Council of New Zealand’s Statement on good prescribing practice about preventing errors in prescribing. In particular, avoiding abbreviations, symbols and ambiguity with dose designations. For example:
- Write the words ‘daily’ or ‘once daily’ rather than ‘OD’, ‘QD’ or other similar abbreviation as this can be mistaken as QID (four times daily)
- Write ‘microgram’ rather than ‘μg’ or ‘mcg’ as this can be mistaken as mg (milligram)
- Write ‘units’ rather than ‘U’ or ‘IU’ as this can be misread as a zero
- Write ‘g’ for gram rather than gm as this can be mistaken as mg (milligram)
- Use words or standard numbers rather than roman numerals, as they are no longer commonly used
Paper of the Week: Do statins really deserve the hate?
Statins are a key component of cardiovascular disease risk reduction. Good adherence to an appropriately dosed statin regimen is shown to reduce the absolute risk of future vascular events in both people with a history of occlusive vascular disease and those without, i.e. primary and secondary prevention. Statins are generally well-tolerated; myopathy is an established adverse effect with an incidence rate of 0.01% (and rhabdomyolysis in rarer and more severe cases) and there is also an increased risk of developing diabetes in people already at elevated risk, e.g. those with impaired fasting glucose or elevated HbA1c. The list of potential adverse effects in the data sheets for statins, however, is extensive, including hepatic dysfunction, depression, impaired cognition, sleep disturbance, acute kidney injury or renal failure, interstitial lung disease and pancreatitis. These effects are typically based on large quantities of observational study data and post-market surveillance. This is understandable given how commonly prescribed statins are but there is some concern that this avalanche of adverse effect warnings may contribute to “statin-hesitancy”.
An article published earlier this year in the Lancet presents a large-scale meta-analysis aiming to clarify whether there is an increased risk of developing any of the potential adverse effects listed in the Summary of Product Characteristics (i.e. European medicines data sheets) for statins. With the exception of myopathy and diabetes (which are established adverse effects and were not assessed), the authors concluded that statin use was only associated with a significant excess risk of four of the other 66 adverse effects listed: abnormal liver transaminases, other liver function test abnormalities, urinary composition alteration and oedema. These findings provide stronger evidence about (the lack of) statin adverse effects outside of what has already been established and reinforce the importance of providing medicines information with appropriate clinical context. The cardiovascular benefits of statins will outweigh the risks for most patients; concerns about developing adverse effects, while understandable, should not be a barrier for patients to receive optimal treatment.
What has been your experience with prescribing statins – do patients regularly report adverse effects after starting a statin? How often do patients decline your offer of statin treatment, or ask for it to be discontinued? What are the some of the reasons patients raise for not wanting to take a statin? What counter-points points do you make in these discussions and how do you encourage adherence to statin treatment?
Read more
- Analysis was carried out on 19 double-blinded randomised controlled trials involving approximately 120,000 participants followed for a median of 4.5 years comparing low-intensity (one trial), moderate-intensity (16 trials) and high-intensity (two trials) statin treatment with placebo
- Only trials with more than 1,000 participants and at least two years of statin treatment were included
- Data from four trials comparing more-intensive statin treatment with less-intensive regimens were also available to investigate dose-dependent relationships
- Study participants were predominantly male (72%) and had a mean age of 63 years. Approximately half of the participants were diagnosed with vascular disease and one-fifth had a history of diabetes.
- Muscle pain or weakness and new-onset diabetes are established adverse effects of statin use and therefore were excluded from this study analysis
- A total of 66 further adverse effects were identified from Summary of Product Characteristics (i.e. European medicines data sheets) from commonly used statins: atorvastatin, fluvastatin, pravastatin, rosuvastatin and simvastatin
- These included liver function test abnormalities, cognitive impairment, depression, sleep disturbance and peripheral neuropathy
- Adverse effects reported by participants during the study period or follow up were identified and a false discovery rate for each of the 66 adverse effects was calculated
- Statin use was not associated with a significant excess risk for 62 of the 66 adverse effects, when compared to placebo. The four adverse effects that were associated with a significant excess risk were: abnormal liver transaminases; other liver function test abnormalities; oedema; and urinary composition alteration, e.g. proteinuria, albuminuria, microalbuminuria.
- Despite the increased risk of liver function abnormalities, no association was found between statin use and other hepatobiliary outcomes, e.g. cholestasis and jaundice, hepatic failure, hepatitis
- The effect on liver function tests increased with higher-intensity statin regimens; notably, the risk was greater for people taking 80 mg atorvastatin than 20 mg rosuvastatin (equivalent potency).
- In contrast, increasing statin intensity did not appear to worsen urinary composition alterations and oedema. As no increased risk of renal outcomes (e.g. acute kidney injury, haematuria) or “other general disorder conditions” (e.g. fatigue, malaise, pyrexia) were found, the clinical significance of the urinary composition alterations and oedema are unknown (in this context).
- One limitation for this study is its applicability. Statins are typically initiated with the intention of being continued long-term; any adverse effects associated with long-term statin treatment may have been missed as the median follow-up period in this study was 4.5 years. The study population was also three-quarters male and likely does not reflect the New Zealand population.
- Persistent elevations in liver transaminases are a common reason to discontinue statin treatment. There is no way of knowing whether participants who experienced these hepatic effects led to withdrawal from their respective study, and whether any abnormalities resolved.
- Data for the meta-analysis also came from adverse event reporting, not laboratory results potentially leading to an underestimate of liver function test abnormalities
- In summary, these findings support the notion that the cardiovascular benefits of statin treatment outweigh the potential adverse effects for many people. Clinicians have a responsibility to present medicines information in a form that ensures the patient can make informed health decisions.
Reith C, Blackwell L, Emberson JR, et al. Assessment of adverse effects attributed to statin therapy in product labels: a meta-analysis of double-blind randomised controlled trials. The Lancet 2026;407:689–703. doi:10.1016/S0140-6736(25)01578-8.
A short video summarising the study findings for patients is available here
For further information on the role of statins in primary care, see: Prescribing statins to reduce cardiovascular risk and Rosuvastatin: another option to lower cardiovascular disease risk
This Bulletin is supported by the South Link Education Trust
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