Published: 5 March, 2021
New Primary Care Update series topic available
A new topic in the musculoskeletal theme is now available – Osteoarthritis: a collaborative approach to management.
To purchase this topic, or to browse other available topics in the musculoskeletal and cardiovascular systems,
For this topic, we are joined by two guests, orthopaedic surgeon Mr John Scanelli and musculoskeletal physiotherapist specialist Associate Professor Ben Darlow.
Together they provide us with a balanced perspective on the journey from diagnosis through to long-term management of osteoarthritis.
We have done things a little differently this time and have split our usual main narrated slidecast presentation into four distinct episodes that you can watch at
your convenience, including: (1) Diagnosis, (2) Non-operative management overview, (3) A focus on exercise, and (4) Surgical management. A written key practice points
summary and CME case study are also included. Our experts emphasised that although surgery is inevitably required for some people, in many cases osteoarthritis
can be effectively managed with education, exercise, weight loss and analgesics.
For a sneak peek of this topic, click here.
Reminder: twice-daily nitrofurantoin now funded
From March 1st, 2021, modified-release nitrofurantoin capsules are fully funded on prescription. We previously reported on this funding
decision in Bulletin 14. Nitrofurantoin is
recommended as the first-line treatment for symptomatic cystitis in adults. The recommended dose is
50 mg, four-times daily for five days, or for seven days in males or pregnant women. A regimen of 100 mg nitrofurantoin modified release, twice daily,
is also suitable, and is likely to improve treatment adherence.
Now that there are two formulations of nitrofurantoin available, this increases the risk of medicine errors. Therefore, it is
recommended that the brand or formulation is specified on the prescription, i.e. Nifuran (immediate release) or Macrobid (modified release).
Be alert for angioedema in patients taking vildagliptin and an ACE inhibitor
In the latest issue of Prescriber Update (March, 2021),
Medsafe cautions prescribers to be aware of the potential increased risk of angioedema in
patients using both vildagliptin and an ACE inhibitor. Angioedema is a known adverse effect when taking an ACE inhibitor alone, but it appears that the
addition of vildagliptin increases this risk; although the absolute risk remains small. Since 2018, CARM has received reports of four cases of angioedema
in patients taking ACE inhibitors and vildagliptin.
Medicine supply information now available in the NZF
From March 1st, 2021, PHARMAC supply information will be added to medicine monographs in the New
Zealand Formulary (NZF). Information on any supply issues,
discontinuations or brand changes are highlighted in a box at the top of the relevant monograph; the
paracetamol monograph displays a current example. This
information is provided by PHARMAC on a weekly basis, and includes links to the PHARMAC website where more information about each notification can be found.
The NZF also contains an index of all current PHARMAC supply notifications.
Other updates in the March release of the NZF include:
Latest medicine supply news
Latest medicine supply information is available on the PHARMAC
website and the NZF.
Supply issues reported in the last week include:
- Furosemide 500 mg tablets
(Urex Forte) are temporarily out of stock. An alternative brand is available (Furosemid-Ratiopharm),
but this is unapproved by Medsafe, therefore must be prescribed under section 29 of the Medicines Act.
- Oestradiol 75 microgram patches (Estradot)
continue to be in short supply. An alternative brand (Estradiol TDP
Mylan, section 29 as above) is available.
- Oxycodone 5 mg controlled release
tablets (Oxycodone Sandoz) are affected by a supply issue. An alternative brand
is available (Oxycodone Sandoz S29, section 29).
- Yes! Cassette Pregnancy
Test (Smith BioMed Rapid Pregnancy test) is affected by further batch recalls; stock must
be replaced. An alternative brand (David One Step Cassette Pregnancy Test) is also available.
- Danazol 100 mg
and 200 mg capsules are to be discontinued from April 1st, 2021. This is an androgenic medicine
indicated for the treatment of angioedema, endometriosis and menorrhagia.
- Timolol 10 mg tablets (a beta blocker)
are to be discontinued from July 1st, 2021.
Information regarding the 2021 Influenza Immunisation Programme
This year's influenza vaccination programme is due to commence on April 14th, with a staggered roll-out beginning with priority groups. Three quadrivalent vaccines
will be available (click “read more” for details),
containing antigens against four strains expected to circulate in the Southern Hemisphere. A vaccine is specifically available for
people aged 65 years and over (FLUAD® QUAD) to ensure adequate supply to this group.
Table 1. Vaccines included in the 2021 Influenza Immunisation Programme.
||Strains of inactivated influenza virus included
|AFLURIA® QUAD JUNIOR
||Children aged <3 years
- A/Victoria/2570/2019 (H1N1)pdm09-like virus*
- A/Hong Kong/2671/2019 (H3N2)-like virus*
- B/Washington/02/2019-like virus†
- B/Phuket/3073/2013-like virus†
||People aged 3–64 years
||Adults aged ≥65 years
* New strains included in the 2021 vaccines; † Strains included in the 2020 AFLURIA® QUAD vaccine.
Orders for the FLUAD® QUAD can be made from March 15th, with distribution anticipated after Easter. Needles are not provided with
this year’s vaccines and will be able to be purchased separately from EBOS or pharmacy wholesalers from March 15th. The dates for the
ordering/distribution of AFLURIA® QUAD JUNIOR and AFLURIA® QUAD will be advised in April.
There will be an initial two-week priority period for people who are eligible for free vaccination; the first week (April 14th – 20th) is only
for adults aged ≥65 years and the second week (April 21st – 27th) extends to all people eligible for funded vaccination.
From April 28th, the vaccination can be extended to the general population.
For more detailed information on the 2021 influenza programme, including who is eligible for funded vaccination, see:
Paper of the week: Evaluating potentially inappropriate prescribing in middle aged adults
Responsible prescribing of medicines is an important daily consideration for clinicians in primary care. Potentially inappropriate prescribing
(PIP) describes medicine use associated with more harm than benefit, that is not cost-effective or that is not clinically indicated. Although PIP has
been extensively investigated in patients aged ≥65 years, where it is strongly associated with polypharmacy and multimorbidity, comparatively little
is known about PIP in middle-aged adults (aged 45–64 years).
A recently published cross-sectional analysis of general practice data in the United Kingdom investigated the prevalence and predictors of PIP in
this age group. It was found that approximately one in five patients aged 45–64 years were inappropriately prescribed a medicine each year. Common
examples of PIP included being prescribed two or more medicines from the same class, long-term use of NSAIDs and long-term, high-dose use of proton pump inhibitors.
- Data was analysed from the records of 1,185,335 patients across 41 general practices in the Lambeth
Clinical Commissioning Group (London) between 2014-2019
- Patients were included in the analysis if they were aged 45–64 years and prescribed at least one medicine
(this ranged from 46,663 people in 2014 to 52,582 in 2019); PIP was retrospectively assessed using the
PRescribing Optimally in Middle-aged People’s Treatment (PROMPT) criteria
- In each of the six years evaluated, at least 18% of the study population received a potentially inappropriate
prescription (ranging from 18% in 2014 to 20% in 2019)
- Approximately half of all patients had two or more long-term conditions, and almost one-third of patients
were prescribed four or more repeat medicines per year
- In 2019, the most common causes of PIP were use of two or more medicines of the same class, using NSAIDs
for longer than three months and using a PPI above the recommended dose for longer than eight weeks
- Risk factors associated with PIP included having patients with polypharmacy and multimorbidity, in
addition to increasing deprivation status and age
Read the full paper here: Khatter A, Moriarty F,
Ashworth M, et al. Prevalence and predictors of potentially
inappropriate prescribing in middle age adults: repeated cross-sectional study. Br J Gen Pract. 2021;
10.3399/BJGP.2020.1048. Online ahead of print.
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