Published: 2 October, 2020
BPJ is back!
We hope that you enjoyed reading our commemorative digital edition of Best Practice Journal, containing a curated collection of our most popular articles
from the last few years. Congratulations to those of you who were lightening quick enough to secure a printed copy – we "sold out" of our 400 copies in just
over six hours! The good news is that there is still plenty of time to enter our competition to win an iPad. If you haven't done so already,
we would love for you to take a look: https://bpac.org.nz/bpj-e/
Reminder: Updated National Immunisation Schedule from 1 October, 2020
As reported in previous bulletins, a new vaccination event
for children aged 12 months has been added to the National Immunisation
Schedule as of 1 October, 2020. The Immunisation Handbook has been updated to reflect all the changes and the 2020 edition is
available online and to download.
The first MMR vaccination will now be given at age 12 months with the second at 15 months, with the aim of providing young children with protection
from measles as early as possible. A third PCV10 vaccination (booster dose) will also be given at age 12 months. Practices will need to recall children
so that doses are not missed. The Ministry of Health advises that children aged 12-14 months should be recalled initially (for first MMR and third PCV-10),
followed by children aged 16-23 months and then children aged two to four years (for second MMR).
N.B. Practices who use Medtech32 or Evolution should be aware that the changes to the schedule will not be implemented until 21 November,
2020 which means that until then, there will be no automated recalls issued for children for the new 12 month event.
IM route of administration now recommended for live vaccines
The Ministry of Health has updated its advice in the 2020
Immunisation Handbook regarding the preferred route of administration for live vaccines such as MMR,
varicella and herpes zoster (shingles): live vaccines should be given by the intramuscular (IM) route (except if there is a bleeding risk – see below).
This change in practice is based on evidence that live vaccines administered via the IM route are safe and effective and result in fewer
localised adverse reactions. It was previously recommended that live vaccines be administered via the subcutaneous (SC) route; some
manufacturers data sheets will still list this route as an option. The SC route is recommended for people who are at risk of bleeding,
e.g. taking anticoagulants, or who have thrombocytopenia or a bleeding disorder.
For further information, refer to Section 2.2.3, Pages 51-5 of the
Immunisation Handbook (2020)
Medicine supply updates:
Latest medicine supply/discontinuation issues are listed on the
PHARMAC website here.
Supply issue with ipratropium bromide and salbutamol inhaler (Duolin)
The supplier of Duolin, the combination inhaler containing 20 micrograms of ipratropium bromide and 100 micrograms of salbutamol, has
notified PHARMAC that this inhaler is now out of stock.
There have been anecdotal reports that supplies of Duolin have been variable for several months, but stock is now depleted nationwide.
The current shortage is due to manufacturing delays and other issues relating to COVID-19. The only alternative option for patients using a
Duolin inhaler is to use an Atrovent inhaler and a salbutamol inhaler together. One inhalation (puff) of Duolin is equivalent to:
- One inhalation (puff) of ipratropium bromide, 20 micrograms (Atrovent), and
- One inhalation (puff) of salbutamol, 100 micrograms
This means that until supply is restored, patients will need two prescription items to replace one Duolin inhaler,
which will also mean they will be charged for two co-payments at the pharmacy. The supplier of Duolin is working to restore stock delivery as soon as possible
Cilazapril (Zapril) 5 mg dispensed monthly from 1 October, 2020
Due to a potential supply issue with the 5 mg strength of the funded brand of cilapril (Zapril),
PHARMAC has advised that all-at-once (three-monthly)
dispensing has been removed from 1 October, 2020 to maintain continuity of supply for this dose formulation. Supply of the 2.5 mg strength is not currently affected.
This is a timely reminder that while cilazapril is widely prescribed in New Zealand, it is not in other countries. This means that there is a
risk of supply issues in the future and PHARMAC have a guaranteed supply until 2022 only. There are several other funded brands of ACE inhibitors in New Zealand.
For further information, see "Prescribing
ACE inhibitors: time to reconsider old habits".
Terazosin to be discontinued
PHARMAC has announced that terazosin,
an alpha-adrenoceptor blocker prescribed to men with benign prostatic hyperplasia, will be discontinued during 2021
with stock anticipated to run out around May, 2021. This is due to supply issues with the current funded brand (Apo-Terazosin) and a lack of success in sourcing
another brand for long-term supply. Those currently taking terazosin need to be transitioned to a different treatment and no new patients should be started on terazosin.
- As of 1 October, 2020, terazosin is only subsidised by endorsement for those who were taking terazosin prior
to October 1, 2020 (pharmacists can annotate the prescription as endorsed if there is a record of prior dispensing)
- The current stocks of Apo-terazosin, in both 2 mg and 5 mg strengths will be exhausted by November, 2020 (the
2 mg strength is possibly already unavailable)
- Teva Terazosin will be temporarily listed on the Pharmaceutical Schedule from 1 October, 2020 and will be available
in both a 2 mg and 5 mg strength, with stock anticipated to run out around May, 2021
- Teva Terazosin is an unapproved medicine in New Zealand therefore it will need to be prescribed under Section
29 (N.B. it is an approved medicine in the United Kingdom)
- Prescribers should start to transition patients who are currently taking terazosin to an alternative medicine
(e.g. doxazosin or prazosin) and ensure that no new patients are started on terazosin from 1 October, 2020
For further information on the alternative funded alpha adrenoceptor blockers, doxazosin and prazosin,
see the New Zealand Formulary.
Tamsulosin and finasteride are also available with Special Authority approval for patients
with benign prostatic hyperplasia who are unable to take a non-selective alpha blocker
(or if symptoms are not adequately controlled in the case of finasteride).
Oestradiol patches: 50 microgram patch now also in short supply
In Bulletin 9
we reported that stock of 25 microgram oestradiol patches was depleted. PHARMAC has
this information to advise that 50 microgram patches are now also in short supply. An alternative brand of 50 microgram
patches, Climara, has been able to be sourced, however, note that Climara patches are applied once weekly
(i.e. every seven days), whereas the original funded brand, Estradot, are applied twice weekly (i.e. every
three to four days). It is anticipated that Estradot 50 mcg patches will be back in stock by mid-October and 25 mcg patches
by the end of October, 2020.
For further information on the role of oestradiol patches and other
treatments for menopausal symptoms, see https://bpac.org.nz/2019/mht.aspx
Happy 100th New Zealand Formulary
We would like to congratulate our colleagues at the New Zealand Formulary (NZF) for the publication this month of their 100th
monthly release of the
The NZF was first published in 2012, followed by the NZF for Children in 2013. The NZF is provided online, free of charge, to all healthcare professionals prescribing,
dispensing and administering medicines across community and hospital care.
Paper of the week: What happened to evidence-based medicine? An opinion piece
Dr Margaret McCartney is a general practitioner from Glasgow, Scotland. She is known for her pragmatic views and insightful commentary.
We have enjoyed many columns that she has written, and wanted to share with you a short opinion piece she wrote recently about the demise of
evidence-based medicine during the COVID-19 pandemic.
"When Donald Trump said that he had a ‘good feeling’ about hydroxychloroquine in the treatment of COVID-19, I had a bad feeling..."
Read Dr McCartney's article here
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