Published: 18 September, 2020
Proposal for new medicines for diabetes to be funded
PHARMAC is currently consulting
on a proposal to fund two new medicines for diabetes – a sodium-glucose co-transporter 2 (SGLT2) inhibitor, empagliflozin
(with and without metformin) and an injectable glucagon-like peptide 1 (GLP-1) receptor agonist, dulaglutide. It is proposed that empagliflozin would be funded
from 1 December 2020, and dulaglutide be funded once it is Medsafe approved. It is proposed both treatment options would be funded for people meeting Special
Authority criteria, with applications by any relevant practitioner. Consultation on this proposal is encouraged by anyone wanting to have their say about the
proposal. Consultation responses can be sent to email@example.com with consultation closing 4pm Friday 2 October 2020.
The proposed funding of these medicines marks an important addition to the "toolkit" for managing patients with type 2 diabetes and is likely to
result in improved patient outcomes. We will update our guidance accordingly in the near future, to include information about the place in treatment of these medicines.
New Zealand Formulary patient information leaflets
The New Zealand Formulary (NZF) has an extensive library of printable patient information leaflets about medicines. Versions in Te Reo Māori are also
available for many frequently prescribed medicines including paracetamol, allopurinol, omeprazole, amoxicillin, bendroflumethiazide, fluticasone, metformin and
vildagliptin. Further Te Reo Māori versions are usually added with each monthly update of the NZF. Patient information leaflets can be accessed
an index page or from the patient advice section of a drug monograph.
Recall of two batches of Smith BioMed Rapid Pregnancy Tests
In Bulletin 7 we advised that Medsafe was monitoring the Smith BioMed Rapid
Pregnancy Test (also known as the Yes! Cassette Pregnancy Test Kits) due to
reports of false positive and inconclusive results. The manufacturer, in consultation with Medsafe,
has now recalled two batches of the test kits. The affected
batch numbers and expiry dates are:
- Batch HCG19110040 exp 2022-11
- Batch HCG19120028 exp 2022-12
Any affected stock will be replaced by the manufacturer.
Supply issues with amlodipine
PHARMAC have advised that all strengths of the funded brand of
amlodipine (Apo-Amlodipine) are in short supply. The 2.5 mg tablet is already out of stock
and the 5 mg and 10 mg tablets are expected to run out by mid to late September. The manufacturer of Apo-Amlodipine, Apotex, is withdrawing from the New Zealand
market so PHARMAC has secured supply of amlodipine through a new supplier. However, stock from this new supplier is not yet available. Two alternative brands of
amlodipine are temporarily listed on the Pharmaceutical Schedule from 11 September, 2020, to bridge the gap in supply. Both of these brands of amlodipine are
unapproved medicines in New Zealand and therefore must be prescribed under
Section 29 of the Medicines Act. A key aspect of this is that the prescriber is
required to obtain patient consent for use of the unapproved medicine.
For further information about prescribing unapproved medicines, see
Paracetamol remains on monthly dispensing
Stocks of paracetamol are now being regularly replenished and the supplier anticipates more stock arriving in New Zealand during September. However,
on dispensing that were implemented in March, 2020, will remain in place for the time being. This is to ensure equitable access to paracetamol across the country that
might arise due to uneven or limited distribution. The additional brand (Panadol Mini Caps) that was listed on the Pharmaceutical Schedule on 12 August, 2020,
currently remains available as a further funded option.
Case of the week: ten men addicted to Ayurvedic medicines (Kamini
and Barshasha) presenting for opioid substitution treatment
Instead of our regular "Paper of the week" segment, we present a special edition "Case of the week" submitted
by Drs Jo Lane and Susan Lane from Waitematā DHB. If you would like to submit a case, please email: firstname.lastname@example.org
Kamini (also referred to as Kamini Vidrawan Ras, KVR) and Barshasha are opioid-containing herbal medicines originating from India, that are becoming increasingly
commonly seen in the community in New Zealand, despite being illegal to import, supply or possess without a prescription. A large police seizure of Kamini recently
took place in Auckland. It is likely that Kamini use is widespread among some groups, and the harm caused by it is underreported.
Since 2013, the South Auckland Unit of the Auckland Opioid Treatment Service has treated ten men addicted to Kamini, one of whom was also using Barshasha.
Most of these men had a history of oral opium use in India prior to immigrating to New Zealand. By the time of admission, all were taking excessively large doses
of Kamini, and attempts to reduce or stop led to severe opioid withdrawal symptoms. The group of men have responded well to opioid substitution treatment
(OST), but all have required higher doses of OST compared to people withdrawing from other opioids.
Primary care clinicians should be aware of the use of Kamini and Barshasha, particularly among the Indian community and followers of Ayurvedic or Unani medicine.
If patients are using these preparations, assess whether they have symptoms and signs of opioid dependence; ask them if they experience any problems when they
miss a dose or try to stop. Local Community Alcohol and Drug Services can provide assistance with patients experiencing difficulties.
Read the full case study here
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