As of 1^st November, 2026:

• All Special Authority and Hospital Indication restrictions that applied to antiretroviral medicines for HIV treatment have been removed
  • “HIV treatment with antiretroviral medicines should only be initiated under the guidance of a clinician experienced in the management of HIV. Practitioners should refer to local health pathways and guidelines” has been added as a Pharmaceutical Schedule note to antiretroviral medicines
• The subsidy by endorsement rule that applied when emtricitabine + tenofovir disoproxil was used as part of a HIV treatment regimen has been removed
• The restriction limiting funding to a maximum of four antiretroviral medicines per person has been removed
• Special Authority restrictions have been removed from antiretroviral medicines for HIV PrEP and PEP
• Funded PEP following an occupational exposure no longer requires prescription from a named specialist, e.g. sexual health or infectious diseases physician
• Up to 30 tablets each of emtricitabine + tenofovir disoproxil and dolutegravir are funded on Practitioners Supply Order (PSO) for PEP if supplied by an authorised practitioner and the PSO is endorsed accordingly. N.B. PEP is an unapproved indication for these medicines; therefore, they cannot be supplied under a standing order for PEP.

Due to shipping delays, it is anticipated that stock of the funded brand of loratadine 10 mg tablets (Loratadine Noumed) may run out. Additional stock is expected to be available by early November but may take some time to reach pharmacies.

Loratadine 1 mg/mL oral liquid is not affected by this supply issue and may be a suitable alternative for some patients. There are also other funded non-sedating oral antihistamines available, e.g. cetirizine, fexofenadine. However, patients will require a new prescription.

The main funded brand of cetirizine oral liquid 1 mg/mL is changing from Histaclear (AFT) to Cetirizine Hayfever & Allergy Relief (Noumed). Cetirizine Hayfever & Allergy Relief will be listed on the Pharmaceutical Schedule and funded from 1^st November, 2026, and Histaclear will be delisted on 1^st April, 2027. Patients will be transitioned to the new brand over this time period, depending on stock availability.

Patients taking cetirizine oral liquid 1 mg/mL (or their caregivers) should be advised that the new packaging will look different, but the active ingredient, strength and flavour (banana) is the same.

Use of unapproved peptide products is continuing to increase both in New Zealand and internationally, with escalating concerns around the safety of these products and the impact on health systems.

If patients ask for advice about unapproved peptide products, or disclose use, they should be warned that they are unregulated, with no assessment of quality, safety or efficacy. Suppliers claims of lab testing should be considered with a high level of scepticism, as results are often misleading and do not represent the true contents or safety of purchased products. In addition, many of these products contain medicines that in New Zealand must only be used on prescription from a medical professional.

Use of unapproved peptide products poses significant risk at multiple stages of administration, with concerns around:

• Contents of product; whether the product contains the substance that is claimed at the concentration that is listed without additional contaminants
• Dosing; without guidance from a medical professional
• Severe adverse effects; often due to overdosing, also injection site reactions

Data from Australia demonstrates that use of unapproved peptides is creating an increased level of harm and pressure on health resources. A NSW Health report showed a sharp increase in the presentation of patients to emergency departments involving use of unapproved peptides between July, 2025 (five presentations) and September, 2026 (217 presentations). In New Zealand, ten cases involving adverse reactions to unapproved peptide products have been reported to the New Zealand pharmacovigilance database to date.

Anyone continuing to use unapproved peptide products should be made aware of needle exchange services, with specific peptide injecting kits and confidential advice on injecting substances available to reduce risk of harm.

Any adverse effects from the use of these products should be treated according to symptoms and reported to the Centre for Adverse Reactions Monitoring.

Superstitions exist to bridge the gap between what cannot be explained to what is observed, a gap that in early medicine was very large. Many disorders were historically explained by beliefs that were later proven to have no correlation to the underlying cause. Most of these beliefs disappeared upon discovery of the true causes, but some still remain.¹ A common theme among persistent superstitions is that the moon and its phases have some influence over our behaviour or health.¹ This ‘Lunar effect’ (sometimes referred to as the ‘Transylvania effect’) has been debated throughout the history of medicine.² Why have the superstitions surrounding the moon been so hard to dispel, and is there any truth to them?

The moon paints itself as the perfect candidate to bear blame for unexplained phenomena, given its prominence in the sky, an easily trackable cycle and its importance in culture and folklore.³ Mental health in particular has strong associations to the moon. The term ‘lunacy’, derived from the Roman goddess of the moon Luna, was used for hundreds of years to describe what would now be known as a broad range of mental health and psychiatric conditions.²

There have been various theories over time as to how the moon could influence health and behaviour. In pre-industrial times, before the advent of streetlights or houselights, the increased light levels from a full moon could disrupt sleep enough to trigger manic episodes in those who were predisposed.² A surprisingly recent theory (1970s) claimed that the moon could create ‘biological tides’ and since humans are comprised largely of water, we too could be changed by the moon like the seas.² While this theory gave rise to a best-selling book^*, the reality that the moons gravity has “less than the effect of a mosquito on one’s shoulder” wasn’t encouraging for this explanation.²

Over time, moon phases have been claimed to influence elements of psychosis, depression, seizures, suicide, aggression, births and perioperative complications.³ Even in medical settings, some healthcare professionals are adamant that a full moon will bring more patients to the emergency department. Despite the ongoing prominence in popular culture and imagination, these correlations have never been convincingly demonstrated.^{3, 4} Studies and statistical analyses cannot find any relation between the moon’s phases and any of the above listed effects, with claims otherwise often exhibiting type I errors (false positive).⁴ Several studies conducted in the 1990s and early 2000s found no correlation between lunar phases and consultations in general practice for anxiety, depression or general mental illness.⁴

While it may be disappointing there is not a scientific basis for werewolves, it does seem humans are not completely immune to the influence of lunar phases. A polysomnography study of 852 individuals in Sweden found that sleep duration of participants was shorter during the waxing (new moon to full moon) period than in the waning (full moon to new moon) period.⁵ It was also found that males in particular were affected, with lower sleep efficiency and more time awake after sleep onset during the waxing period.⁵ These associations remained after adjustment for confounding factors, such as sleep apnoea and insomnia, an additional strength over previous studies.⁵ While a causative link was not proven, the authors hypothesised that despite modern lighting and screen usage, the presence of extended brightness from a waxing moon could be a factor. Interestingly, this finding mirrors the theory that increased moonlight causes disruptions in sleep and may be responsible for a ‘lunar effect’, but this extra interpretation would need its own study before any further claims could be made.

In discussing health with patients, it may become apparent that they are holding a superstition as to why they have certain conditions. In these circumstances it is important not to be immediately dismissive, but rather to explore the reasons for these beliefs and respectfully correct any misinformation or gaps in knowledge. Often, it can be an effective coping strategy for patients to create an alternative narrative to explain a health concern, especially when medical science does not give all the answers. Provided these beliefs do not result in negative self-management strategies, they are unlikely to cause harm.

So, next time a patient tells you they howl at the moon, it may be worth considering that while many of the superstitions attached to the moon have not been proven, there are others that cannot be put to bed.

* How the Moon Affects You, by Arnold Lieber (1978); republished 1996

References:

1. St. Amour B, DeHart WB. Magic medicine. HCA Healthc J Med 2020;1. doi:10.36518/2689-0216.1117
2. Iosif A, Ballon B. Bad Moon Rising: the persistent belief in lunar connections to madness. Can Med Assoc J 2005;:1498–500. doi:10.1503/CMAJ.051119
3. Foster RG, Roenneberg T. Human responses to the geophysical daily, annual and lunar cycles. Curr Biol 2008;18:R784–94. doi:10.1016/j.cub.2008.07.003
4. Owens M, McGowan IW. Madness and the moon: The lunar cycle and psychopathology. Ger J Psychiatry 2006;9:123–7.
5. Benedict C, Franklin KA, Bukhari S, et al. Sex-specific association of the lunar cycle with sleep. Sci Total Environ 2022;804:150222. doi:10.1016/j.scitotenv.2021.150222

The use of GLP-1 receptor agonists for weight management is increasing across all demographics. However, there is particular interest in these medicines among women who are trying to optimise their chance of pregnancy. There is limited evidence as yet to determine any direct effects on fertility in the general population, but the parameters that GLP-1 receptor agonists target, are also beneficial for increasing the chances of becoming pregnant, such as weight loss and improving glucose tolerance. In people with polyendocrine metabolic ovarian syndrome, evidence is emerging that GLP-1 receptor agonists can improve metabolic and reproductive outcomes. It is important, however, to discuss any potential benefits of treatment in the context of the patient’s individual circumstances. For example, if a patient is not overweight, using a GLP-1 receptor agonist to improve fertility will not necessarily improve success rates, while exposing the patient to unnecessary adverse effects.

Further reading on this topic: Merhi, Z, Karekar M, Mouanness M. GLP-1 receptor agonist for weight loss and fertility: Social media and online perception versus evidence-based medicine. PLoS One. 2025; 20(7):e0326210. doi: 10.1371/journal.pone.0326210

Have you had patients ask about GLP-1 receptor agonists for improving fertility? If so, how did you navigate this conversation?

What patient factors do you consider when determining whether initiating a GLP-1 receptor agonist for pre-conception weight management is appropriate?

How confident are you about giving advice on when specific GLP-1 receptor agonists should be stopped prior to trying for pregnancy?

Continuation of a GLP-1 receptor agonist once pregnant is associated with potential risks and is not recommended; however, weight gain associated with discontinuation may increase the risk of adverse gestational outcomes.

What advice do you give patients about stopping a GLP-1 receptor agonist if they become pregnant? What additional support do you put in place to help them manage potential “rebound” weight gain during pregnancy, while still ensuring adequate nutrition and healthy weight gain?

Post-pregnancy is often a time that patients are anxious to lose weight quickly and return to their previous physique. However, uncertainty remains regarding the safety of GLP-1 receptor agonist use while breastfeeding. Further research on the potential indirect effects of treatment, e.g. on milk volume, nutritional density or composition, is required. For this reason, a shared decision-making approach is needed, considering the potential risks and benefits, as well as other options for weight loss. Careful monitoring of infant weight gain is imperative if a GLP-1 receptor agonist is used while breastfeeding. Treatment with a GLP-1 receptor agonist is not recommended while breastfeeding for people with pre-term infants or neonates (aged < 4 weeks).

What other factors would influence your clinical decision-making regarding GLP-1 receptor agonist treatment in a patient who is breastfeeding?