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Published: 3 September, 2020


Something exciting is coming...

We are preparing to launch a new twist on an old favourite. Coming to your inbox very soon, watch this space.

Primary care update series: new topic now available

The first topic in our "Musculoskeletal theme" is now live – Gout: what's in and what's out. We are joined by Associate Professor Simon Stebbings, Consultant Rheumatologist, to discuss the latest evidence for managing gout in primary care.

Here is a "sneak peek" audio snippet:

To access this topic and others in the Primary Care Update series, click here

Reminder: upcoming changes to National Immunisation Schedule

From 1 October, 2020, a new vaccination event for children aged 12 months will be added to the National Immunisation Schedule, to give the first dose of MMR and booster (third) dose of PCV10. We covered all the changes to the Immunisation Schedule in a previous bulletin. Printed resources, such as the National Immunisation Schedule reference card, have been updated and are now available to order on the HealthEd website. The 2020 edition of the Immunisation Handbook will be available online in mid-September.

For the Ministry of Health information about these changes, click here

Avoid prescribing allopurinol with azathioprine

In the latest edition of Prescriber Update (September, 2020), Medsafe warns prescribers to avoid the combination of allopurinol with azathioprine or mercaptopurine due to a risk of life-threatening bone marrow suppression. The Centre for Adverse Reactions Monitoring (CARM) has received 13 reports of bone marrow suppression occurring with concomitant use of allopurinol and azathioprine.

Antihistamines should not be used for sedation in children

The Medicines Adverse Reaction Committee (MARC) has recommended that the indication of sedation be removed from over-the-counter medicines containing sedating antihistamines. Promethazine (brand names Phenergan and Allersoothe) is the only oral sedating antihistamine available for use in children aged two years and over. Sedation with an antihistamine may be considered in some settings prior to a minor medical or surgical procedure in a child, and anecdotally some parents may enquire about a sedating antihistamine for long-haul travel or troublesome sleeping in younger children. MARC considered that there were other more appropriate methods if sedation was required in a child in a medical setting, and that the over-the-counter sale of promethazine for sedation in children was inappropriate.

N.B. this advice does not apply to use of antihistamines for other indications.

Celiprolol to be discontinued

The supplier of the beta-blocker Celol (celiprolol) has advised PHARMAC that this medicine will be discontinued. This brand is the only one currently registered in New Zealand which means that celiprolol will be unavailable once the current stocks are depleted. Patients will need to be changed to another beta-blocker.

For further information on selecting a beta-blocker, see:

Supply issue with 25 microgram oestradiol patches

PHARMAC has advised that supplies of the 25 microgram oestradiol transdermal patch are low and likely to have been depleted by the end of August. No replacement brand has been able to be sourced, therefore patients will need an alternative treatment option until supplies are restored (e.g. switching to oral tablets or using a higher strength patch). New stock is expected by mid-October, 2020. It is important to note that this only affects the 25 microgram patch; supplies of the other sizes of oestradiol patch (50, 75 and 100 microgram) are not affected.

For further information on the role of oestradiol patches and other treatments for menopausal symptoms, see

Paper of the week: More than a (gut) feeling

A unique study has been published this week in the British Journal of General Practice, examining the utility of a general practitioner's "gut feeling" in diagnosing cancer in primary care. The authors identified 16 studies or resources published on this topic and were able to perform a meta-analysis of outcomes. They found that the pooled odds of a cancer diagnosis were four times higher when gut feelings were recorded in the notes, and that the accuracy of gut feelings in predicting cancer increased with the clinical experience of the general practitioner and their familiarity with the patient.

Friedemann Smith C, Drew S, Ziebland S, Nicholson B. Understanding the role of GPs' gut feelings in diagnosing cancer in primary care: a systematic review and meta-analysis of existing evidence. Br J Gen Prac 2020;70(698): e612-e621. DOI:

This Bulletin is supported by the South Link Education Trust

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