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Discontinuation of the combination product cilazapril with hydrochlorothiazide tablets

Apo-Cilazapril/Hydrochlorothiazide® has been discontinued and supply in NZ is expected to run out by July 2020. We recommend all patients taking this product be reviewed and changed to an alternative treatment. From 1st March, prescriptions for existing patients will need to be annotated for funding. See PHARMAC guidance for more details.

Cilazapril tablets are still available and hydrochlorthiazide is available in combination with quinapril.

Note: cilazapril is not used widely overseas and there is potential for supply issues in the future. It is suggested to consider the fully funded long-acting ACE inhibitors, enalapril, perindopril and lisinopril, which are used widely internationally. 

Hydrochlorthiazide has a shorter half-life and weaker evidence base than other widely available thiazide diuretics. It is recommended to consider the fully funded long-acting thiazide diuretics, chlortalidone, bendroflumethiazide and indapamide.

See Health Pathways and BPAC guidance for advice on management, or contact the Christchurch Medicines Information Service for advice on specific patients.

Ranitidine recall update (09/12/19)

The availability of ranitidine is extremely limited. Famotidine IV/oral is currently funded for hospital use, and 20 mg tablets will be fully funded in community from 1st January 2020 under Section 29 (unlicensed medicine). 

See Medsafe’s statement for more details on the product recall – https://www.medsafe.govt.nz/safety/Alerts/MedicinesAndNDMA.asp 

 

Alternative management options include:

Gastroesophageal reflux disease (GORD):

  • consider trialling cessation of H2-antagonist therapy
  • lifestyle modification (e.g. avoiding foods that trigger symptoms, such as alcohol and caffeine)
  • antacids e.g. aluminium (e.g. Alu-tab 600 mg tablets – fully funded)
  • alginates (Gaviscon Double Strength®tablets and Acidex® liquid – partially funded)
  • proton-pump inhibitors – omeprazole, pantoprazole and lansoprazole are all fully funded. Also suitable to use in pregnancy
  • See HealthPathways for more guidance https://canterbury.communityhealthpathways.org/24341.htm  (Canterbury only)

 

Chronic urticaria: 

Pregabalin is now fully funded

Pregabalin is a gabapentinoid that is now fully funded and indicated as an option for patients with neuropathic pain, as well as focal seizures and generalised anxiety (unlicensed). Pregabalin may offer advantages over gabapentin in patients where adherence to a three-times-daily regimen is problematic or where gastrointestinal absorption may be impaired. The efficacy of gabapentinoids should be reviewed after initiation and dose escalations, as many patients obtain minimal benefit but experience adverse effects. Gabapentinoids also have the potential to be abused. For more information, see the bulletin published by the CDHB Analgesic Stewardship Committee on our website.