• Allergy to the Pfizer COVID-19 vaccine is more commonly reported than allergies to other vaccines (5-11 people per million doses); it is most common in females and in people with a history of allergy, and usually occurs a short time after administration of the first dose (within 30 minutes)
• It is thought that the most likely causative allergic component in the Pfizer COVID-19 vaccine is polyethylene glycol (PEG); people with a PEG allergy should be discussed with an immunologist prior to receiving any doses
• People with an immediate anaphylactic reaction to the COVID-19 vaccine can usually receive a second dose but only if it is able to be administered within a specialist immunology clinic (currently available in Auckland, Wellington and Christchurch); if this is not possible, a second dose should not be given
• People with a delayed allergic reaction can usually receive the second dose of the COVID-19 vaccine; an antihistamine can be given prior to or following the dose
• Most people with a history of anaphylaxis with another vaccine, medicine, food or venom, an atopic condition such as asthma, dermatitis or rhinitis or a family history of allergy can safely receive COVID-19 vaccination
• People with a history of allergic reaction who are receiving the COVID-19 vaccination should be closely observed for 30 minutes and given clear advice on symptoms to be alert for after they leave
• Delayed reactions such as facial swelling, urticaria or rash are usually self-limiting but can be treated with antihistamine if necessary

Bromocriptine is a dopamine-receptor agonist most often used in Parkinson's disease, and also used for people with hypogonadism, galactorrhoea, prolactinoma, acromegaly, as part of fertility treatment (hyperprolactinemic amenorrhoea) and for prevention of lactation.

Bromocriptine is supplied in New Zealand by Apotex who are leaving the market, and PHARMAC have been unable to find an alternative ongoing supplier. To help to ensure supply for existing patients for as long as possible, no new patients can be prescribed bromocriptine. Only patients who have been taking bromocriptine before 1 March, 2021 will have access to funded bromocriptine. If there is a previous record that bromocriptine has been dispensed, pharmacists can endorse the prescription.

Short-term supply of an alternative unapproved brand of bromocriptine is available for use in pregnant women so they do not need to change their treatment. The brand is Parlodel (Novartis) and it has been funded since July, 2021 with supplies expected to last until January, 2022.

There are other fully funded dopaminergic medicines available for the treatment of people with Parkinson's disease: refer to the NZF for options. Cabergoline may be a suitable funded alternative treatment for people who are currently taking bromocriptine for an endocrine condition such as hyperprolactinaemia. The Special Authority criteria have been amended to allow widened access.

• A new monograph for naltrexone + bupropion hydrochloride.  This unfunded oral medicine is a centrally acting appetite suppressant indicated as an adjunct for weight management.
• A new monograph for upadacitinib, a selective and reversible inhibitor of the Janus-associated tyrosine kinases (JAK) which leads to a reduction in the activation of immune and inflammatory process. It will be available under Special Authority criteria for patients with moderate to severe rheumatoid arthritis.
• A new monograph for vortioxetine, a serotonin modulator which works in several ways to increase the amount of available serotonin in the brain, resulting in antidepressant effects. It is indicated for use in patients with major depressive disorder but is not funded. 
• Changes to therapeutic notes including section updates for topical estrogen for vaginal atrophy and COVID-19 vaccines
• Changes to medicine monographs include an update for apixaban and a new indication for rivaroxaban for the prophylaxis of cardiovascular events in patients with coronary artery disease or peripheral artery disease. Several monographs for vaccines have had updates to cautions and contra-indications. The cautions section of the ivermectin monograph has also been updated.
• The Patient Information Leaflet section contains a new link to patient information for empagliflozin (Health Navigator) in the following languages: Cook Islands Māori, Samoan, Tongan, Tuvaluan, Tokelauan, Niuean, Traditional Chinese, Simplified Chinese, and Hindi

Mā te whakarongo, ka mōhio
Through listening, comes knowledge

Mā te mōhio, ka mārama
Through knowledge, comes understanding

Mā te mārama, ka matau
Through understanding, comes wisdom

Mā te matau, ka ora
Through wisdom, comes wellbeing

In this episode, the Good GP interviews GP registrar Dr Lena Rennick who has OCD, and Dr Scott Blair-West a consultant psychiatrist and medical director of the OCD programme at the Melbourne Clinic.

OCD is under recognised and under diagnosed. There are often behaviours that are apparent in adolescence (even childhood) yet typically a diagnosis is not reached for many years. OCD is typified by intrusive thoughts, images, anxiety and compulsive behaviours and can have a significant impact on functionality. The effects on concentration and focus can adversely impact schoolwork or work and ultimately lead to depression.

The panel discusses the use of screening questions (e.g. do you check a lot? clean and wash a lot? go over things again and again? have rituals that you do every day?) and things to watch for (e.g. a patient presenting with dermatitis due to excessive hand washing). The COVID-19 pandemic has aggravated behaviours in many people with OCD, particularly regarding issues of excessive cleanliness and uncertainty. The panel notes that everyone has intrusive thoughts, but it’s an abnormal response to these thoughts that characterises OCD.

OCD behaviours can be obscure and irrational and provoke shame and embarrassment, making the patient reluctant to reveal them. One of the key aims is to encourage people to talk about their behaviours, to normalise the problem and to recognise the significance of the presenting features so that diagnosis is not delayed. OCD can underlie anxiety and depression and it is often not recognised that it can be at the root of these conditions.

One area not covered in the podcast is perinatal OCD. It is estimated that 2-3% of women, and some fathers/partners, experience perinatal OCD. Often the intrusive thoughts revolve around fears that the baby could come to harm in some way. Perinatal OCD is considerably more common than perinatal psychosis so it’s important that primary care health professionals consider this.

Listen to the full podcast on OCD here

Patient information on perinatal OCD for parents in New Zealand is available here: https://pada.nz/wp-content/uploads/2021/04/Perinatal-OCD.pdf

An OCD-UK video on perinatal OCD is available here: https://vimeo.com/263327393