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Published: 30 October, 2020


Medicine Safety Week

Medicine Safety Week is being marked around the world from 2nd – 8th November. The purpose is to raise awareness of adverse medicine reactions; the theme for 2020 is "Your report matters". You may notice increased social media activity on this theme during the week. It serves as a reminder to primary care prescribers and other health professionals to report any adverse medicine reactions in patients, even if you are uncertain whether there is an association. This includes suspected reactions to any medicine, vaccine, complementary medicine/product or psychoactive substance. Reports can be made to CARM through your Adverse Reaction Reporting tool in your patient management system or via a variety of other methods: click here for more information from CARM about reporting.

Codeine reclassified as a prescription only medicine

From 5th November, 2020, codeine-containing products will no longer be able to be purchased over-the-counter. The only combination codeine product currently funded on prescription is paracetamol 500 mg + codeine 8 mg. Other combination codeine products can be prescribed, however, patients will need to pay the full cost of the medicine and some products may no longer be available. We have published a two-part series to offer further information and guidance about this change. The first article is an overview, describing the decision to reclassify codeine and providing information about prescribing codeine and other analgesics. The second article covers a community pharmacy perspective and discusses strategies for providing pain management advice.

New CVD risk assessment tool for patients

The long-awaited patient CVD risk tool, updated to reflect the New Zealand risk assessment equations, is now available on the Heart Foundation website. My Heart Check is free to use and gives patients an estimate of their CVD risk, including a comparison of their "heart age" to their chronological age. Patients may proactively use the tool and want to discuss the results with a primary healthcare professional, or it may be used as a prompt for discussion during a consultation, to help emphasise the importance of lifestyle changes to improve CVD health.

For further information on CVD risk assessment, see:

Oestradiol patches: Estradot supply further delayed and new brand added

In Bulletin 9 we reported that there was a stock shortage of Estradot oestradiol 25 microgram patches and in Bulletin 11 we reported that this stock shortage now also included the Estradot 50 microgram patches. It was anticipated that stocks would be replenished by the end of October, but the latest update from PHARMAC on 21st October states that stock is now not expected until December. This reflects ongoing global supply issues for oestradiol patches and some oral contraceptives due to the COVID-19 pandemic. An alternative brand of oestradiol patches, Climara (applied once weekly), was listed to cover the shortage, however, supplies are now limited for this brand. An additional brand, Estradiol Mylan Patches (25 microgram and 50 microgram, applied twice weekly) will be listed and funded from 1 November, 2020. This brand is not an approved medicine in New Zealand, therefore can only be prescribed by a medical doctor under Section 29.

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

Apotex medicines affected by market withdrawal

In Bulletin 5 we reported on the withdrawal of medicine manufacturer, Apotex, from the New Zealand market. PHARMAC has prepared a list of affected medicines, including those that will be discontinued, replacement plans underway and the timeframes for these changes. This resource is likely to be useful for prescribers and pharmacists.

What's in the flu vaccine for next year?

For those of you with an increased attention to virology and vaccines this year, you may be interested to see the recommended influenza composition for New Zealand in 2021, published by Medsafe. A quadrivalent vaccine is recommended, covering strains of H1N1, H3N2 and Influenza B. Collection of data on the 2020 influenza season in New Zealand has been limited due to the COVID-19 pandemic, but anecdotally it has been a mild season, likely due to increased hygiene and personal protective measures, and restricted travel. ESR influenza surveillance data shows that among the 229 specimens collected from sentinel practices between June and September, 2020, no positive influenza samples were found. In comparison, 57% of the 1617 specimens collected in 2019 were positive for influenza.

Paper of the week: Long-term consequences of adversity in childhood

It will come as no surprise that adverse experiences during childhood lead to negative outcomes in adulthood. However, an interactive analysis just published in the BMJ brings together research in this field to show some rather startling results:

"Disruption of the development of the brain architecture and other organ systems can increase lifelong risk for mental and physical disorders. Such impacts can be observed across multiple systems, affecting cardiovascular, immune, metabolic and brain health, and may extend far beyond childhood, impacting life course".

Interventions for optimising development, health and nutrition need to be implemented as early as possible in a child's life. One of the key recommendations that the authors make is that interventions should be measured not only by their influence on mental health and behaviour, but on their impact on other health outcomes including asthma, diabetes and cardiovascular disease.

Read the full paper, including interactive charts and visual summary, here.

Nelson C, Scott R, Bhutta Z, et al. Adversity in childhood is linked to mental and physical health throughout life. BMJ 2020;371:m3048.

This Bulletin is supported by the South Link Education Trust

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