Published: 20 August, 2020


COVID-19 "Auckland August" cluster

We are aware of the increase in workload and stress for primary care with the recent new outbreak of COVID-19 in Auckland. This has obviously had a significant impact on practices in Auckland who are now operating under Level 3, but also affects all primary care practices around the country who are managing unprecedented levels of demand for COVID-19 testing. This occurs along with other patient behaviours we have previously experienced with COVID-19 restrictions such as early requests for repeat prescriptions and an increase in health-related anxiety. This is simply an acknowledgement of the pressure that primary care is currently under, and a message of support from the bpacnz Publications Team, three of whom are GPs.

Additional brand of paracetamol listed

There are ongoing supply issues with the funded brand of paracetamol tablets (Pharmacare) due to the COVID-19 pandemic. A number of alternative brands of paracetamol were listed on the Pharmaceutical Schedule on 22 July, 2020, but stocks of these are now also depleted. An additional brand (Panadol Mini Caps) was listed on 12 August, 2020, however, stock may not yet be available for supply; this will be updated on the PHARMAC website. It is understood that stock levels of paracetamol around the country are variable and some pharmacies may not currently be able to fill paracetamol prescriptions. Note that the current restriction of paracetamol to one-month supply also applies to the alternative brands.

Update on Norimin supply issues and replacement options

Norimin, a combined oral contraceptive, is currently out of stock, but supply is expected to be restored by mid-October. PHARMAC initially listed an alternative product, Necon, to cover the out-of-stock period. However, stock of Necon is expected to run out by late-August. Brevinor 28 day, which contains the same active ingredients as Norimin and Necon, will be listed from 1 September, 2020, as an alternative, however, stock of Brevinor 28 is anticipated to run out at the end of October.

Information for community pharmacists: Brevinor 28 can be substituted for Norimin or Necon if patients have any repeat prescriptions owing. All of these brands are restricted to three-month dispensing.

For further information, see: https://www.pharmac.govt.nz/information-for/enquiries/oral-contraceptives-supply-updates/ethinyloestradiol-35mcg-with-norethisterone-500mcg-norimin/

For further information on selecting a contraceptive, see: www.bpac.org.nz/2019/contraception/options.aspx

Discontinuation of oxazepam

PHARMAC has announced that the supplier of oxazepam, Douglas Pharmaceuticals, is to discontinue this medicine in New Zealand and an alternative supplier has not been identified. The current brand of oxazepam is the only one approved by Medsafe. This decision will affect approximately 4,600 people who are currently prescribed oxazepam. Supplies of the 10 mg tablet will run out in mid-October, 2020 and the 15 mg tablets in mid-November, 2020. Once the stock is depleted, PHARMAC will delist the medicine from the Pharmaceutical Schedule. Prescribers should:

  • Consider whether a benzodiazepine is still clinically indicated
  • Provide advice to patients currently taking oxazepam so that they can change to an alternative medicine or slowly discontinue the oxazepam as it should not be stopped abruptly
  • Not start oxazepam as a new treatment option for any patients

Discontinuation of Pulmocare

The suppliers of Pulmocare, an oral feed indicated for patients with COPD, have discontinued this product and it will be delisted from the Pharmaceutical Schedule on 1 October, 2020. PHARMAC state that Ensure Plus or Fortisip may be acceptable alternatives for patients affected by this change. Ensure Plus and Fortisip are funded with Special Authority approval, and earlier this year the restrictions were changed to include additional funding by endorsement for patients with COPD and hypercapnia (defined as a CO2 value > 55 mmHg); refer to the Pharmaceutical Schedule for further information.

Reminder to avoid fluconazole in pregnant women

Topical intravaginal antifungal treatment is the first-line treatment for vulvovaginal candidiasis in pregnant women. Although oral antifungal medicines such as fluconazole should be avoided in pregnancy, previous data on pregnancy outcomes in women exposed to short courses and low doses was reassuring, therefore some clinicians may have considered fluconazole as a "last resort" in pregnant women if intravaginal treatment had not resolved symptoms. However, a recent study has concluded that any dose of fluconazole during pregnancy is associated with risk and it should not be used in pregnant women. As fluconazole is available as a Pharmacist only medicine, it is also imperative for pharmacists to be aware of the importance of ruling out pregnancy before providing fluconazole.

For further information on managing vaginal candidiasis, see: "Vulvovaginal health in premenopausal women", available from: https://bpac.org.nz/BPJ/2011/december/vaginal.aspx

Paper of the week: NICE draft guideline on chronic primary pain

In this section, rather than our usual focus on a research paper we draw your attention to a newly released draft guideline from the National Institute for Health and Care Excellence (NICE), United Kingdom, on managing chronic pain in people aged over 16 years. The guideline is now open to review and comment from clinicians in the UK and it has already generated some heated debate.


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