Published: 11 December, 2020
Are you up to date with what’s new in the NZF?
A new monograph for empagliflozin,
a sodium-glucose co-transporter 2 (SGLT-2) inhibitor for patients with diabetes has now been included in the NZF. Empagliflozin
is currently being considered for funding by PHARMAC with a decision expected in early February.
For further information on the PHARMAC proposal, see https://pharmac.govt.nz/news-and-resources/news/update-on-funding-decision-for-diabetes-medicines
Guidance on the management of stroke is now updated, including
the place and timing of short term dual anti-platelet therapy, e.g. aspirin and clopidogrel, and changes to advice
on secondary prevention, e.g. high potency statins recommended irrespective of the patients’ lipid levels.
There are changes in a number of other guidance sections in the December NZF release. Did you know you
can sign up to receive monthly emails about significant changes in the NZF? This is a good way to keep up to date
with what is new.
- Nausea and vomiting in pregnancy – the information
in this section has been updated
- Menopausal hormone therapy –
the notes section on the management of menopausal symptoms includes advice based on current evidence about both
menopausal hormone therapy and non-hormonal therapy. Several non-hormonal medicines (e.g. SSRIs, SNRIs and gabapentin)
have unapproved indications for the management of vasomotor symptoms, particularly hot flushes.
- Diverticular disease –
this section now reflects current management of diverticular disease and diverticulitis, e.g. minimising antibiotic
use where possible
- Severe Cutaneous Adverse Reactions (SCARs) – this
guidance section outlines the identification and management of these potentially life-threatening skin reactions,
e.g. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), Erythema Multiforme and Stevens-Johnson Syndrome
drugs – the “blue box” section on the link between suicidal thoughts and actions, and antidepressant treatment
has been updated
HIV PrEP harms event reported
The Centre for Adverse Reactions Monitoring (CARM) has been informed of a harms event occurring during the prescription
and dispensing process of HIV pre-exposure prophylaxis (PrEP) in a primary care setting. This resulted in the prescription
of tenofovir disoproxil monotherapy rather than the combination product emtricitabine with tenofovir disoproxil. This
has highlighted the importance of prescribing by active ingredients (in this case: emtricitabine/tenofovir disoproxil)
rather than by supplier/sponsor (“Teva”). In addition to prescribing by generic name, CARM suggest that the indications
for prescription should be confirmed with the prescriber or patient at the time of dispensing as this should reduce
the likelihood of a preventable harms event.
Unlike the combination emtricitabine/tenofovir PrEP product, tenofovir disoproxil monotherapy can be dispensed without
Special Authority approval. However, it is only indicated as monotherapy in patients with chronic hepatitis B. For
HIV treatment and prevention strategies, it is always used in combination with other antiretroviral medicines.
For further information on PrEP, see https://bpac.org.nz/2019/prep.aspx
National contraception guidance out now
The Ministry of Health’s guidance on contraception has been published
and is available here. This document covers
a range of issues specifically intended for a New Zealand audience and includes information on providing effective
contraception counselling, contraception following pregnancy and the range of contraception options available. bpacnz will
be updating our contraception article series to reflect the new guidance.
Paracetamol supply issues ongoing
PHARMAC advise that there are ongoing issues with the supply of paracetamol tablets and that supply is affected at
a global level. There are multiple reasons for this with issues at various stages of manufacture and supply, and damage
to a recent shipment resulting in rejection of product. Further supplies are expected in mid-December which will ease
demand, but it is not expected that the problems will be fully resolved for several months.
Paper of the week: New WHO guidelines on Physical Activity
The World Health Organization (WHO) have released
their new Guidelines on Physical Activity and Sedentary Behaviour.
This document updates their 2010 guideline and provides recommendations largely at a public health level, but also
with direct relevance to primary care. The evidence-based recommendations reflect the changes in research on physical
activity which have occurred over the intervening years since the previous guideline.
The guidelines include specific recommendations for children, adolescents, adults and older adults and now also
subpopulations, e.g. women who are pregnant or postpartum and people with long-term health conditions and disability.
There is more of an emphasis on the ideas around the WHO definition of health as “a state of complete physical,
mental and social wellbeing”. The guidelines also highlight the associations of sedentary behaviour with poorer
health outcomes including cardiovascular, cancer and all-cause mortality, and the incidence of diabetes, cancer
and cardiovascular disease. They also stress the importance of physical activity in older adults for the prevention
of falls, and fall-related injuries, and the maintenance of functional ability and bone health.
One of the key changes relates to new evidence that shows improved health outcomes are associated with physical
activity of any duration. It was previously advised that there should be a “minimum threshold” for bouts
of activity of at least ten minutes duration, but this advice has been removed. The guidance is now that “doing
some physical activity is better than doing none” and although specific daily or weekly targets are given, it recognises
the importance of any activity at any intensity and a reduction in sedentary behaviour when possible.
- Doing some physical activity is better than doing none
- All people should limit the amount of time they spend being sedentary
- Replacing sedentary time with physical activity of any intensity is recommended to reduce the detrimental effects
of a high level of sedentary behaviour
- Activity should be individualised – start with small amounts and gradually increase frequency, duration and
- In general:
- Children and adolescents should aim for at least 60 minutes of physical activity per day (moderate to vigorous
intensity) with vigorous intensity aerobic activities on at least three days a week PLUS muscle and bone strengthening
activities at least three days a week
- Adults (18-64 years) should aim for at least 150–300 minutes (moderate intensity) OR 75–150 minutes (vigorous
intensity) per week. In addition, they should also include muscle strengthening activities at moderate or greater
intensity involving all major muscle groups at least two days a week. If an individual is able to increase the
amount of aerobic physical activity throughout the week, e.g. >300 minutes of moderate or >150 of vigorous
intensity, this provides additional health benefits, although these begin to plateau beyond 300 minutes per
- Older adults have similar targets recommended, but should also add in varied multicomponent physical activity
to improve strength and functional balance on three or more days a week. They should aim to be as active as their
fitness and functional ability allows.
- Modified guidance applies to women who are pregnant or postpartum, adults who have chronic conditions and children,
adolescents and adults living with disability
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