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Storage of medicines per manufacturers’ specifications ensures medicines are fit for purpose. If stored outside these specifications, or used beyond the expiry date, medicines may be less effective, and/or have increased toxicity. This bulletin provides a framework for considering whether medic...
Medicines and Meals – Food for Thought? - June 24, 2024
The timing of medicine administration in relation to food is not important for most medicines. In general, patients should be advised to take their medicines consistently at the same time with respect to meals.
Adherence to medicines is a primary determinant of treatment success.
Poor adh...
SGLT2 Inhibitors and GLP-1 Receptor Agonists - January 3, 2024
Sodium-glucose co-transporter 2 inhibitors (SGLT2i) e.g. empagliflozin & glucagon-like peptide-1 receptor agonists (GLP1RA) e.g. dulaglutide & liraglutide are increasingly being used in NZ for type 2 diabetes and other conditions such as heart failure & obesity. Currently their funded...
Analgesia during pregnancy or while breastfeeding - July 5, 2023
Treatment of pain in pregnant and breastfeeding women should follow the same principles as for all adults, using the analgesic ladder:
Step 1: Paracetamol and/ or NSAID, e.g. ibuprofen or diclofenac
Step 2: Add a weak opioid for mild to moderate pain, e.g. codeine, tramadol
Step 3: Chang...
Can transdermal patches be halved? - May 16, 2023
Sometimes it is necessary to give a lower patch dose than is available. This problem has become more frequent with supply issues for some patch doses. Manipulation of a dose form can affect pharmacokinetics and stability, although there are very few studies involving patches. Cutting or occluding...
Antidepressant Use in Pregnancy - March 31, 2023
Depression affects approximately 10% of pregnant people and is associated with adverse parental and foetal outcomes, including compromised parenting, which can impact on child development.(1) Some data suggest that antidepressants may increase the risk of spontaneous abortion, preterm delivery an...
Treatment of Nausea and Vomiting in Pregnancy - January 23, 2023
Nausea, with or without vomiting, is common in pregnancy, affecting up to 80% of women. Symptoms usually begin between four and seven weeks, peak at nine weeks, and resolve by 16 to 20 weeks. Up to 2% of women develop hyperemesis gravidarum, where persistent vomiting may lead to dehydration, weig...
Crushing nirmatrelvir+ritonavir (Paxlovid®) tablets - December 22, 2022
Background
Pfizer state in their prescribing information that both nirmatrelvir and ritonavir tablets should be swallowed whole and not chewed, broken, or crushed. [1] This is due to a lack of pharmacokinetic data to support administration in this manner. However, a Phase 1 study with a nirmatre...
Pharmacokinetic medicines interactions with probenecid - November 29, 2022
Probenecid was introduced in the 1950’s to reduce the renal elimination and extend the plasma half-life of penicillins. This effect is exploited therapeutically in the treatment of cellulitis and other infections. It is also used for gout prophylaxis, in light of its uricosuric effects.
Prob...
Taking Complementary and Alternative Products with Your Medicines - November 7, 2022
Key points:
There is far less information about how well complementary and alternative products work and how safe they are compared to medicines.
There are no rules in Aotearoa NZ to make sure the contents are what the label says. This makes it difficult to say whether the...