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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, click here.

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.


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 currently 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.

For more detailed information on the 2021 influenza programme, including who is eligible for funded vaccination, see: https://www.influenza.org.nz/

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.

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; doi: 10.3399/BJGP.2020.1048. Online ahead of print.

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