Published: 16 October, 2020
Update on oral contraception supply issues and replacement options
Ongoing global manufacturing and distribution constraints on all ethinylestradiol and norethisterone products has led to oral contraceptive supply issues in New Zealand.
We have reported on this evolving situation in several bulletins.
Norimin (ethinylestradiol 35 micrograms + norethisterone 500 micrograms), a combined oral contraceptive
currently out of stock. Supply is now not expected to be
restored until mid-February, 2021. PHARMAC listed equivalent alternative brands, Necon and Brevinor 28, to
cover the out-of-stock period, however, supplies of these medicines are expected to run out by mid-October, 2020,
and availability is variable across the country. PHARMAC are working with suppliers to seek a further alternative to Norimin.
Another COC, Brevinor-1 28 (ethinylestradiol 35 micrograms + norethisterone 1 mg), is also now
of stock. Supply is not expected to be restored until mid-February, 2021. There are currently no equivalent alternative brands.
Choosing an alternative contraceptive
As chemically equivalent brands of Norimin and Brevinor-1 28 are unavailable, patients using these oral contraceptives will need to switch to an alternative.
There are several funded contraceptive options available, including other oral contraceptives, intermediate- or long-acting contraceptives
(i.e. depot injections, implants, intra-uterine devices), and barrier methods.
Planning NZ recommend that no new prescriptions should be given for Norimin (or substitutes) or Brevinor-1 28 because they are unlikely
to be available and patients will have to return for another prescription. If a patient already taking one of these brands needs to be switched
to another oral contraceptive, consider the following:
- Levlen or Femme-Tab (ethinylestradiol 30 micrograms + levonorgestrel 150 micrograms) are reasonable alternatives, although they do contain
a lower dose of ethinylestradiol and a different progestogen than Norimin and Brevinor-1 28
- Ginet (ethinylestradiol 35 micrograms + cyproterone acetate 2 mg) has the same dose of ethinylestradiol but a different progestogen than Norimin
and Brevinor-1 28. N.B. Cyproterone is associated with a higher risk of venous thromboembolism than levonorgestrel or norethisterone.
- Changing to a progestogen-only pill (POP) may be suitable; Noriday (norethisterone 350 micrograms) contains the same progestogen as Norimin. The
different pill-taking rules for POPs need to be carefully explained, i.e. the narrow window for dosing error. This option is unlikely to be appropriate
for patients who are at risk for poor adherence, or who are taking a COC for non-contraceptive benefits, e.g. cycle regulation, relief from menstrual
pain, heavy menstrual bleeding, acne.
- Non-funded or partly-funded oral contraceptives are also available if cost is not a barrier, e.g. Yasmin
As supply problems with oral contraceptives is an evolving issue, it is recommended to regularly check the
for the latest information on any stock shortages.
For further information on selecting a contraceptive, including long-acting options, see:
Be aware of psoriasis exacerbations in people taking bupropion
Medsafe has issued a monitoring alert regarding a possible risk of
exacerbation of psoriasis in people using bupropion. This is based on one case report from CARM of a
patient with pre-existing psoriasis who experienced a flare of psoriasis 15 days after he began taking bupropion for smoking cessation. There are several published case
reports from other countries detailing similar reactions. Other medicines already known to exacerbate psoriasis include beta-blockers, ACE inhibitors, lithium, anti-malarials and NSAIDs.
If a patient with psoriasis experiences an exacerbation while taking bupropion, or a patient experiences new-onset psoriasis, consider stopping bupropion to
observe if the reaction improves, and report the case to CARM.
PHARMAC announces new Principal Supply Status
PHARMAC is changing its competitive procurement policy, for contracts commencing from July, 2021, to allow for more than one brand of a medicine to be funded; this already occurs
in some cases, but the new policy will allow consistency to this approach. Sole Supply Status (and Hospital Supply Status) will be replaced by Principal Supply Status. This means that
there would be a main brand of a medicine funded, but flexibility in allowing a small volume of other brands of that medicine to also be funded. Patients who were unable to take the
main funded brand could have access to another brand that may be listed with Special Authority approval or funded through the exceptional circumstances framework. It appears that
the main reason underlying this decision is to improve the brand change process.
Read the full statement from PHARMAC here.
Pharmacist Prescribers can now apply for Special Authority approvals
As of 1 October, 2020, registered pharmacist prescribers can apply for Special Authority approvals for specific restricted medicines. Previously, applications could only be
made by medical practitioners, dieticians, nurse practitioners and optometrists (depending on the medicine). In rural areas in particular, this may mean that patients are
able to access medicines faster and at a lower cost, e.g. if they no longer need to consult with another prescriber in a different location for a prescription renewal.
There are currently 36 practising pharmacist prescribers in New Zealand.
Read more here.
Colmar Brunton are conducting a survey on our behalf, to ask our readers about what they like about our products and what they would like to see improved.
You should have received an email and reminder about doing this survey, containing your unique survey link. If you did not receive the email, or it's lost in a full inbox,
and you would still like to have your say, you can
do the survey here.
N.B. The survey takes around 10 minutes to complete; using the general link above you will not be able to return to complete the survey
later if you run out of time. Responses close on Tuesday, October 20th.
Paper of the week: COVID-19 in healthcare and support workers in New Zealand
The Ministry of Health has just released a report detailing the demographics of health care and support workers diagnosed with COVID-19 during the first wave of the
pandemic in New Zealand. The report provides some insights into the pathways of transmission in health workplaces. It is reported that 11% of COVID-19 cases in New
Zealand (excluding the Auckland August Cluster) were among health care and support workers. Of the cases that were acquired in health care workplaces, only 10%
(10) occurred in a community health care setting, which suggests that effective infection prevention control measures were in place.
Key findings of the report, which included data to 12 June, 2020, were:
- There were 167 cases of COVID 19 in health care and support workers
- Of these, 96 people were likely to have been infected in their workplace – 42 were likely to have been infected by a patient, resident or
client and 32 were likely to have been infected by another health care worker (the transmission pathway was unable to be determined in the remaining cases)
- Nine health care and support workers required hospitalisation as a result of COVID 19, with two receiving intensive care; all were aged under 65 years.
There were no deaths.
- Health care assistants/caregivers in aged residential care were most affected (63% of cases) and most transmission between health workers and
patients/residents occurred in this setting
- Of the 10 cases acquired in community health care settings, 7 were among health care assistants/caregivers/support workers, 1 was a doctor,
1 was an administrator and 1 other; no nurses or allied health professionals were affected in this setting. Five cases were likely
transmitted by a patient and four cases were likely transmitted by another health
care worker (one was unknown).
- Most health care and support worker cases were part of a cluster, with the largest numbers in Canterbury (48),
Waitematā (37), Waikato (21) and Auckland (18) DHBs
the full report here: "Ministry of Health. COVID-19 in health care and support workers in Aotearoa New Zealand. Oct, 2020, Ministry of Health, Wellington."
This Bulletin is supported by the South Link Education Trust
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