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Published: 25th September, 2026
Contents
New – Upfront: Hip dysplasia in adolescents and young adults
Picture this – your next patient is an active teenager who plays football, presenting with hip and groin pain. It’s likely to be a muscle strain, right? You would be correct in most cases, but in a small but clinically important group, the underlying problem is a structurally shallow acetabulum, otherwise known as hip dysplasia. The typical presentation is slow-onset, activity-related groin and/or lateral hip pain in a young person (usually female) involved in a pivoting sport such as gymnastics, dance or football. Contrary to what you might expect, this is not necessarily a case of missed infant screening – hip dysplasia can also develop during child and adolescent growth. Hip dysplasia is one of the leading causes of hip osteoarthritis before the age of 50 years, and it is often undetected. Surgical treatments to preserve a young person’s natural hip joint work optimally before osteoarthritis sets in. Therefore, early recognition of young people with hip dysplasia is crucial for improving their long-term outcomes.
Guest author, Orthopaedic Surgeon, Dr Matthew Boyle takes us through the causes of hip dysplasia in adolescents and young adults, how to identify and initially investigate it, including three tests that every primary care clinician should know, when and how to refer for surgical assessment, and the ongoing role of primary care.
Read the full article here
Rewind: Wrap-up of recent key messages
Key dates and updates on news items from recent editions of Best Practice Bulletin:
- From 1st October, 2026, Special Authority will be removed from rosuvastatin. This will mean that anyone who needs rosuvastatin can receive funded treatment. See Bulletin 151 for details.
- Another brand of modified-release methylphenidate, Rubifen LA, will be funded from 1st October, 2026, for the treatment of ADHD and narcolepsy. It is a generic version of Ritalin LA; see Bulletins 137 and 151 for further information. Stock of the 10 mg and 20 mg strengths is available to order now. Stock of the 30 mg is expected to be available by the end of September and the 40 mg and 60 mg strengths by late October.
For information on the pharmacological management of ADHD, click here.
- The starting age for bowel screening is due to be lowered from age 58 years to 56 years from 30th September, 2026 (as reported in Bulletin 150). Details of the roll-out are not yet available, but it is expected that this change will be phased in over time.
- The supply issue affecting ezetimibe + simvastatin (Zimybe; last reported in Bulletin 148) now affects all tablet strengths. Alternative brands of various presentations will be listed on 1st October, 2026. View the latest supply information here.
- Supply issues affecting sildenafil 25 mg and 50 mg tablets remain ongoing (as reported in Bulletin 154). An alternative brand of the 25 mg tablets (Crescent; Section 29) will be listed on 1st October, 2026. An alternative brand of the 50 mg strength has been available since August.
- Stock of codeine 60 mg tablets, New Zealand packaged oestradiol valerate 2 mg tablets and naproxen 250 mg and 500 mg tablets has arrived in the country following a period of limited supply (as reported in Bulletins 148, 149 and 156)
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.
Escitalopram upcoming brand change
The main funded brand of escitalopram, a SSRI, is changing from Escitalopram (Ethics) to Ipca-Escitalopram from 1st February, 2027. The Ipca-Escitalopram brand is currently funded and Pharmac report that most people in New Zealand are already taking this brand of escitalopram.
Advise patients taking Escitalopram (Ethics) that their brand will change between now and February and reassure them that there has been no change to the active ingredient. While Ipca-Escitalopram will be suitable for the majority of people, there may be some who have trialled it in the past and found that it was not clinically suitable. In these circumstances, prescribers can apply via the Named Patient Pharmaceutical Assessment (NPPA) process for consideration of continued funding of the Ethics brand of escitalopram.
Prazosin brand change
The funded brand of prazosin, used for hypertension, Raynaud’s phenomenon and benign prostatic hyperplasia, is changing from Mylan to Apo-Prazosin from 1st October, 2026. The Apo-Prazosin brand has been approved by Medsafe (the Mylan brand is not approved; Section 29). The Mylan brand will continue to be supplied until the end of October; a delisting date is yet to be announced. Reassure patients that there has been no change to the active ingredient, however, Apo-Prazosin comes as a tablet rather than a capsule. Some patients may already be familiar with this brand as it has been funded in the past.
Pharmacists are being advised that Apo-Prazosin has the same Pharmacode as Arrotex-Prazosin S29. From 1st October, existing Pharmacodes will be updated to the Apo-Prazosin brand and the Section 29 and wastage rules will be removed.
A patient information sheet about the brand change is available here
Limited stock of tranexamic acid 500 mg tablets
The supplier has limited stock of tranexamic acid 500 mg tablets, an antifibrinolytic. Tranexamic acid ampoules are not affected by this supply issue. An out-of-stock situation is not expected; however, pharmacies may receive less stock than usual until the next shipment arrives, which is expected by the end of September.
Supply issue affecting sumatriptan 50 mg and 100 mg tablets
Sumatriptan 50 mg and 100 mg tablets (Sumagran), used for acute migraine and cluster headache, are expected to go out of stock at the supplier level due to a manufacturing issue. A re-supply date is not currently known. An alternative brand (Sumatriptan Viatris) will be listed on the Pharmaceutical Schedule on 1st October, 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 will come in a bottle of nine loose tablets rather than a blister pack.
Additional strengths of levothyroxine to be funded
Pharmac has announced that from 1st February, 2027, additional strengths of levothyroxine tablets will be funded for people with hypothyroidism. Specifically, a 75 microgram strength of both the Synthroid and Eltroxin brands will be funded. A 25 microgram strength of Eltroxin will also be funded. This will mean that both Synthroid and Eltroxin brands of levothyroxine tablets will be available in 25, 50, 75 and 100 microgram strengths.
This decision was made in response to clinical advice that the currently funded strengths of levothyroxine do not always allow for a convenient dosing regimen for patients, particularly as precise dose adjustments are often required. The availability of additional funded strengths of levothyroxine may simplify dosing regimens, e.g. by reducing the need to take multiple strengths on different days of the week, as well as enable dose titration for patients requiring small dose adjustments.
Decision to extend pharmacy services
Health New Zealand and Pharmac have announced that from 1st October, 2026, the range of funded clinical services and medicines that can be offered in community pharmacy will be extended to include:
- Mild dermatitis treatments for children, e.g. hydrocortisone 1% cream, cetomacrogol cream
- Bacterial and fungal infection treatments for children, e.g. hydrogen peroxide 1% cream, clotrimazole 1% cream
- Oral thrush treatments for children, e.g. miconazole oral gel 20 mg/g
- Vaginal thrush treatments for people of all ages, e.g. clotrimazole 2% vaginal cream with applicator, fluconazole 150 mg capsules
- Oral contraceptives for people aged 16 – 52 years, e.g. ethinyloestradiol (20 or 30 micrograms) with levonorgestrel (100 or 150 micrograms), desogestrel 75 microgram tablets
- Emergency contraception for people of all ages: levonorgestrel 1.5 mg tablets*
* Pharmacists can already provide funded emergency contraceptives to people of all ages. From October, consultations provided by pharmacists will be part-funded by Health New Zealand for people of all ages (currently limited to people aged under 30 years).
Pharmacists may already provide some of these medicines to certain groups of patients; the difference is that these medicines will be funded when supplied by a pharmacist. Pharmacies who choose to offer these services will be able to supply these funded medicines directly to eligible patients without a prescription under the Integrated Community Pharmacy Services Agreement (ICPSA) Extended Pharmacy Service. This decision expands on the extended pharmacy services that were introduced in June, 2026 (as reported in Bulletin 148). These additions were made following consideration of feedback received during the initial proposal (as reported in Bulletin 146).
Consultations provided by pharmacists will be part-funded by Health New Zealand for eligible people. An extended pharmacy service consultation fee may apply to people accessing these services and prescription co-payments will remain.
View the full list of medicines that will be funded on direct supply from a pharmacist from 1st October, here. Click here for the list of medicines that have been funded since 1st June. Further information about extended pharmacy services is available here.
Proposal to widen access to febuxostat for gout
Pharmac is seeking feedback on a proposal to widen access to febuxostat. Currently, febuxostat is funded with Special Authority for people with gout who have trialled both allopurinol and probenecid. It is proposed that from 1st February, 2027, the requirement to have trialled probenecid will be removed from the Special Authority criteria. Therefore, if a patient is unable to achieve serum urate targets with allopurinol or if allopurinol is not suitable, clinicians can choose either probenecid or febuxostat as a second-line treatment option.
Consultation closes on Wednesday, 30th September. This link contains an online form to complete.
For further information on the management of gout, see: https://bpac.org.nz/2025/gout.aspx
RNZCGP guidance on cognitive screening in fitness to drive assessments
The RNZCGP has released guidance on the use of cognitive screening tools to support the assessment of an older person’s fitness to drive. Routine cognitive screening (using cognitive screening tools) during fitness to drive assessments is no longer recommended. However, clinicians should continue to consider a person’s cognitive function as part of an overall assessment; this may still include the use of a cognitive screening tool, at the clinician’s discretion, when indicated.
This follows recent research in New Zealand that demonstrated current evidence does not support the routine use of cognitive screening tools for assessing fitness to drive in older people who are physically and mentally healthy. Use of a cognitive screening tool, e.g. mini-ACE, was not found to be a reliable predictor of driving ability, and was only useful to determine whether cognitive impairment was present or absent. Decisions around fitness to drive should be made following consideration of the person’s overall health status, driving history and safety risk as well as clinical judgement.
Read more
- Routine use of cognitive screening tools during fitness to drive assessments is no longer recommended
- Cognitive screening tools can be used at the clinician’s discretion when indicated to determine the presence or absence of cognitive impairment, but they should not be used in isolation to determine a person’s fitness to drive
- If use of a cognitive screening tool is appropriate, the mini-ACE is recommended for most patients, but consider using:
- MANA for Māori patients aged ≥ 55 years
- RUDAS for patients where English is not their first language or patients with lower health literacy
- If cognitive impairment is identified, consider further assessment that is relevant to driving performance, e.g. Trail Making Test. Also undertake broader assessment of cognitive function, which may include a traffic situational understanding and road safety test.
- If there is uncertainty regarding driving safety, an on-road safety test (free) or referral for occupational therapy driving assessment (cost involved) may be required
- Patients with known cognitive impairment should not undergo cognitive screening; a comprehensive cognitive assessment is required as part of determining fitness to drive. See HealthPathways for details.
- Ideally, the fitness to drive assessment should be carried out by a clinician who is familiar with the patient as this can help to determine whether cognitive screening and/or assessment are likely to be required
The bottom line: Decisions around fitness to drive should be based on assessment of the person’s overall health status, driving history and safety risk as well as clinical judgement.
The RNZCGP guidance is intended to be used alongside the Medical aspects of fitness to drive: a guide for health practitioners from the NZ Transport Agency Waka Kotahi (NZTA).
National guidance on contrast media use in patients with reduced kidney function
New national guidance on contrast media use in patients with reduced kidney function has been published by the National Radiology Network. The guidance reflects current evidence that the benefits of imaging usually outweigh the small risk of contrast-related kidney damage regardless of the patient’s eGFR level. Planned contrast imaging should not be the sole reason why medicines are adjusted or renal function is tested.
Read the full guideline here. A summary of the guideline is also available.
2026 ESC guidelines for heart failure now available
New European Society of Cardiology (ESC) heart failure guidelines have been released, providing clinicians with further direction in the prevention, diagnosis and management of heart failure. The core treatment principles of heart failure are largely unchanged; the 2026 guideline, however, includes several important updates to the previous version (2021), particularly around terminology and classification of disease.
Read more
Some of the key changes include:
- Introduction of a new heart failure staging system, from Stage A (at risk of heart failure) to D (advanced heart failure despite optimal treatment)
- Simplified heart failure classification, including removal of the term “heart failure with mildly-reduced ejection fraction”. Heart failure is now classified as either with reduced ejection fraction (LVEF < 50%) or preserved ejection fraction (LVEF ≥ 50%).
- Greater focus on prevention, early detection and intervention in patients at risk of heart failure
- Acute heart failure has been renamed as decompensated heart failure
- Broader initial assessment, including the addition of urine ACR to baseline investigations
- New terminology for heart failure treatment, replacing the term “guideline-directed medical therapy (GDMT)”. The terminology now describes three treatment groups:
- Foundational medical therapy – treatments with the strongest evidence for improving morbidity and/or mortality for the general heart failure population. For patients with HFrEF, this is an ARNI/ACE inhibitor/ARB, beta blocker, MRA and SGLT-2 inhibitor (previously referred to as GDMT). For patients with HFpEF, this is a MRA and SGLT-2 inhibitor.
- Additional medical therapy – treatments with evidence that supports improved symptoms/quality of life or improved outcomes in specific patient groups. These treatments are individualised to patient co-morbidities, e.g. loop diuretics, GLP-1 receptor agonists, IV iron.
- Guideline-directed interventional therapy – recommended implantable devices or interventional therapies for some patients, e.g. implantable cardioverter-defibrillators
- New and updated recommendations for specific medicines based on recent evidence, e.g. a MRA is now recommended regardless of left ventricular ejection fraction, semaglutide or tirzepatide should be considered for patients with symptomatic heart failure, LVEF ≥ 45% and a BMI ≥ 30 kg/m2, regardless of diabetes status
Read the full guideline here. Click here to skip ahead to the “What’s new” section.
A commentary on what the guidelines mean for primary care from an international perspective is available from Medscape, here
For further information on diagnosing and managing patients with heart failure in primary care, see: https://bpac.org.nz/2025/heart-failure.aspx
N.B. We intend to review the implications of the 2026 ESC guidelines for bpacnz heart failure resources in due course, however, the core treatment principles in these resources are still relevant, i.e. an ARNI/ACE inhibitor/ARB, beta blocker, MRA and SGLT-2 inhibitor continue to be recommended for patients with HFrEF.
Pharmac seeking members to join the Pharmacology and Therapeutics Advisory Committee (PTAC)
Pharmac is currently seeking applications from healthcare professionals to become a member, or Chair, of the Pharmacology and Therapeutics Advisory Committee (PTAC) in 2027. Ideal candidates would have experience in primary care or cancer care, or with population groups that have higher health needs. PTAC provides clinical advice and recommendations to assist Pharmac with making funding decisions for medicines and medical devices.
Further information on required applicant experience and qualifications, as well as how to submit an application can be found here. Applications close on Monday, 12th October, 2026.
CPD Corner: Upcoming webinars + recent podcast episodes
Upcoming Goodfellow Unit webinars
The Goodfellow Unit, University of Auckland, is hosting several free access webinars in October. Webinars are often recorded and available to watch at a later date. Upcoming webinars include:
Upcoming HealthPathways webinar
HealthPathways is hosting an upcoming webinar on assessing suspected acute coronary syndrome (ACS) safely in the community. This free webinar is expected to cover key information about the new national ACS pathway and how to apply it in clinical practice, including safety check points within the pathway, interpretation of high-sensitivity troponin results and indications for hospital referral. The webinar will be held on Wednesday, 21st October, from 7 pm – 8 pm. Click here to register (a certificate of attendance and CPD points are available). A recording will be available at a later date.
Upcoming IMAC webinar
The Immunisation Advisory Centre (IMAC) is hosting an upcoming webinar on recent infectious disease outbreaks and emerging global infections. This free webinar is expected to cover zoonotic infectious diseases, such as avian influenza, hantavirus Andes virus, an Ebola virus (Bundibugyo), as well as diphtheria. The webinar will be held on Tuesday, 29th September, from 12 pm. Click here to register. A recording will be available at a later date.
Latest episodes from The Specialist GP
‘The Specialist GP’ is a New Zealand–based podcast for primary care health professionals, created and hosted by Dr Louise Kuegler. Recent episodes include:
Food for Thought: Is it time to raise ferritin thresholds for diagnosing iron deficiency?
Food for Thought is a slight variation on our usual Paper of the Week for those who are pressed for time. We aim to provide thought-provoking questions relating to a recent publication that you might want to discuss with your colleagues over a quick coffee or other opportunistic moment.
The American Society of Hematology (ASH) has recently published clinical guidelines with evidence-based recommendations for diagnosing iron deficiency, proposing higher serum ferritin thresholds for children aged nine months to four years (≤ 20 micrograms/L) and adults (≤ 30 micrograms/L), including females who menstruate or are pregnant. A higher threshold (≤ 50 micrograms/L) is also specified for people with risk factors for iron deficiency, e.g. low dietary iron intake, impaired absorption, abnormal uterine bleeding. For people with anaemia of inflammation (e.g. inflammatory bowel disease, coeliac disease, chronic kidney disease) the guidelines recommend ferritin < 100 micrograms/L or transferrin saturation < 20% as thresholds for iron deficiency.
In New Zealand, a ferritin level of < 20 micrograms/L is usually considered indicative of iron deficiency in adults (< 15 micrograms/L in children), independent of other iron study results.
Points for discussion
The ferritin thresholds in the ASH guidelines are considerably higher than those used by laboratories in New Zealand, particularly for people with symptoms or risk factors for iron deficiency.
How do you interpret ferritin results when investigating suspected iron deficiency? Are there specific clinical situations that change the ferritin threshold you use for diagnosing iron deficiency?
Do you think it would improve your clinical decision making and/or patient outcomes if the ASH thresholds were adopted in New Zealand?
The guidelines panel prioritised not missing a diagnosis of iron deficiency (i.e. avoiding false negatives) over incorrectly identifying people as iron deficient (i.e. avoiding false positives). The reasoning was that a missed diagnosis of iron deficiency can be associated with adverse health consequences, while the risk of adverse effects associated with iron treatment was considered to be small.
Do you usually stick to laboratory cutoffs for ferritin, or do you take a flexible approach when determining whether treatment for iron deficiency is appropriate for patients with “borderline” levels, e.g. menstruating females with ferritin between 20 – 50 micrograms/L?
How do you discuss the risks and benefits of treatment (with both oral and parenteral iron formulations) with patients? Are there any clinical scenarios in which you consider the risks to outweigh the benefits?
See Bulletin 153 for discussion about the risks associated with ferric carboxymaltose IV infusions
Powers JM, Lim MY, Achebe MO, et al. American Society of Hematology 2026 guidelines for diagnosis of iron deficiency. Blood Adv 2026;:bloodadvances.2025015950. doi:10.1182/bloodadvances.2025015950.
Let us know how we did: Do you like Food for Thought or do you prefer the conventional Paper of the Week write-up? Email: editor@bpac.org.nz.
The final word: A special acknowledgement for our pharmacist colleagues
Today is World Pharmacists Day. We would like to take this opportunity to acknowledge and celebrate the clinical expertise, dedication and value that pharmacists bring to patients, healthcare teams and communities every day. World Pharmacists Day is celebrated each year on the 25th of September. The theme for this year is: Empowering pharmacists for healthier futures. Find out more here.
This Bulletin is supported by the South Link Education Trust
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editor@bpac.org.nz
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