News

Potential impurity in ranitidine formulations

Medicines containing ranitidine have been recalled by some overseas regulatory authorities because of nitrosamine contamination. Nitrosamine is potentially carcinogenic. Medsafe have taken a more conservative approach and not yet made any recalls. However, GlaxoSmithKline (NZ) Ltd has issued a medicine level recall (pharmacy level only) effective 30/9/19 of all Zantac Injection 50mg/2mL and put a halt on further supply until further information is available.

Please see Medsafe’s alert for guidance: https://www.medsafe.govt.nz/safety/Alerts/MedicinesAndNDMA.asp.

Withdrawal of dosulepin (dothiepin) and doxepin from New Zealand

Two tricyclic antidepressants (TCAs), dosulepin (dothiepin) and doxepin will no longer be available in New Zealand.

When transitioning patients to alternatives, consider:

  • Is a TCA still appropriate? TCAs are associated with a higher risk of adverse outcomes in people with cardiovascular disease and older adults.
  • Individual psychiatric history. Switching therapy increases the risk of relapse of mental illness and psychosocial support and/or referral may be needed.
  • Antidepressant discontinuation syndrome. TCAs are associated with discontinuation symptoms, particularly if stopped abruptly after more than 4 weeks of regular use.
  • Individual TCAs are not dose equivalent. Dose titration may be needed when switching to another TCA.
  • Dosulepin (dothiepin) and doxepin are sedating antidepressants, switching to a less-sedating antidepressant (e.g. SSRI, nortriptyline) may cause sleep problems.

For general information on switching antidepressants, discontinuation symptoms and their relative adverse effects see nzf.org.nz/nzf_2225. Health professionals are also welcome to contact our service for more specific or detailed advice on switching therapy.

Notifications from PHARMAC regarding the withdrawal of these medicines:

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.