Pharmac Update: Primary Care Prescribers for the week ending 09 December 2022
Citalopram 20 mg tablets: Brand change
The funded brand of citalopram is changing from PSM Citalopram to Celapram. We expect stock of PSM Citalopram to begin running out during December 2022, and people taking citalopram will need to change to the Celapram brand sometime during December 2022.
Celapram has been approved by Medsafe for use in New Zealand and has previously been supplied in New Zealand.
With Health Navigator, we have developed a pamphlet in a range of languages that you can download and print for patients or their whānau:
o Health Navigator factsheet: English
o Health Navigator factsheet: Te Reo Māori
o Health Navigator factsheet: Samoan
o Health Navigator factsheet: Chinese (Simplified)
Please visit our website for more information.
Oxytocin 10 iu per mL: Temporary alternative s29 brand listed
The supplier of Oxytocin BNM 10 iu per mL has advised that due to a shortage of glass ampoules, this strength of the injections will be out of stock between December 2022 and February 2023.
Boucher and Muir have sourced stock of their Australian registered pack of oxytocin 10 iu per mL, Oxytocin GH, to ensure there is continued access to this medicine. We expect this to be available to order in mid-December 2022.
Oxytocin GH is not currently approved by Medsafe and will need to be prescribed and supplied in line with Section 29 of the Medicines Act. Pharmac has encouraged BNM to get in touch with Medsafe about seeking the necessary consents for this brand, however, this process takes time, and we are advised that approval may not be granted before this supply issue is resolved.
We know supplying an unapproved medicine is not ideal, especially in locations where a doctor might not be immediately available to prescribe the medicine as is required by the legislation. However, in this case, introducing an unregistered product is the only option to ensure there is a 10 iu per mL product available.
This supply constraint only affects Oxytocin BNM 10 iu per mL, and there is sufficient stock of Oxytocin BNM Inj 5 iu per mL to support use where a registered product is needed.
To preserve the registered Oxytocin BNM 5 iu per mL for use where a doctor is not available to prescribe in accordance with section 29, we suggest that hospitals use the unregistered Oxytocin GH 10 iu per mL within services where the section 29 prescribing requirements may be more easily
managed. This will reserve the registered Oxytocin BNM 5 iu per mL for use in health care services where a doctor is not immediately available.
Information for Lead Maternity Carers and Healthcare Practitioners involved in antenatal care: We understand discussing the use of an unregistered product and gaining consent for this may be challenging during childbirth. Because of this, we suggest discussing this with women due to deliver between now and March as part of their birth plan.
Further information is available on the Pharmac website.
Ibuprofen Oral liquid 20 mg per ml, 200 ml bottle: Supply issue
Due to unusually high demand and shipping delays for ibuprofen liquid, there has been a constraint on supply. The supplier, Multichem, had put their stock on strict allocation to allow for equitable access across the motu.
A shipment was due in January 2023. However, Multichem are now air freighting this stock to ensure product is available in New Zealand. It's expected to arrive in mid-December 2022.
Supply will continue to be under allocation until the next sea shipment which is due to arrive in New Zealand by end of January/early-February 2023. Once this shipment arrives, all back orders will be filled.
Further information is available on the Pharmac website.
Entecavir 0.5 mg tablet: Temporary alternative brand listed
Sandoz has advised of a temporary supply issue affecting entecavir 0.5 mg tablets due to manufacturing constraints. Re-supply of Entecavir Sandoz is expected in early March 2023.
We have sourced stock of an alternative brand, Entecavir Mylan, which has been funded from 1 December 2022, and will be available from mid-December. This coincides with when Entecavir Sandoz will become unavailable. Entecavir Mylan has been approved by Medsafe for use in New Zealand. People using Entecavir Sandoz will need to change to the alternative brand to continue to access this medicine.
Further information is available on the Pharmac website
Somatropin (Omnitrope): Temporary alternative brand listed 21 November
Sandoz has advised of a temporary supply constraint affecting somatropin (Omnitrope) injections. We have sourced stock of the Australian packs of somatropin (Omnitrope), and these have been funded from 21 November 2022. Re-supply is expected in late January 2023.
The formulation, containers, and manufacturer are the same, the only differences are on the labels, due to Australian regulatory requirements, and the indications in the leaflets. The leaflet included in the Australian pack has fewer indications than the New Zealand product.
The Australian packs are not currently approved by Medsafe for use in New Zealand and will need to be prescribed and supplied under Section 29 of the Medicines Act.
The same Special Authority restrictions will continue to apply to the Australian somatropin (Omnitrope) injections.
Please visit the Pharmac website for further information.
Fluticasone (Flixotide Accuhaler) 100 mcg: Supply issue
GlaxoSmithKline has advised that there is a temporary delay in the resupply of the Flixotide (Fluticasone) aerosol inhaler, 100 mcg. Due to continued freight delays, there will be a brief out of stock. The supplier advises us that they expect stock of the inhaler to arrive by early December 2022.
Further information is available on the Pharmac website.
Aqueous cream: Potential supply issue
We have temporarily relisted Evara brand aqueous cream to support continuity of supply. Evara was listed on 1 December 2022. It will be removed from the Schedule on 1 April 2023.
We understand that some batches of Evara brand aqueous cream have an unusual smell. If pharmacists have this stock, they can contact Evara for replacement product. To get replacement stock for cream with unusual smell, contact Evara.
Further information is available on the Pharmac website.
Carbamazepine (Tegretol CR)
tab long-acting 200 mg: Supply issue
Due to freight delays, the supplier has advised that there will be a brief delay to the re-supply of carbamazepine (Tegretol CR) tab long-acting 200 mg. The supply issue only affects carbamazepine (Tegretol CR) tab long-acting 200 mg 100 pack. There is stock of other strengths and presentations of carbamazepine.
The supplier has secured stock of the Australian pack. It has been funded from 21 November 2022. This pack is Medsafe approved.
Further information is available on the Pharmac website.
Dulaglutide (Trulicity): Supply issue
Eli Lilly has advised of a global supply issue affecting dulaglutide (Trulicity) due to a significant increase in demand. We have been advised that stock volumes in New Zealand are sufficient to meet demand at this stage.
Our clinical advisors recommend that we prioritise dulaglutide for people already taking it. Further information, including a list of alternative products, are available on the Pharmac website
Testosterone (Depo-Testosterone and Sustanon) injections: Supply issue
There have been supply constraints for both Depo-Testosterone and Sustanon Ampoules. we understand that Depo-Testosterone is at quality assurance at Healthcare Logistics. It will take time for supplies to clear quality assurance and make their way through the supply chain to pharmacies. Sustanon ampoules were resupplied in mid-November 2022. It may take time for the product to reach pharmacies.
The alternative product we listed, Taro-Testosterone, is not yet available. Taro-Testosterone is not currently approved by Medsafe for use in New Zealand and will need to be prescribed and supplied under Section 29 of the Medicines Act.
For further information, please see the Pharmac website.
Oestradiol (Estradot) patches: Supply issue update
There have been several disruptions to supply of the Oestradiol (branded as Estradot) patches since August 2020.
Availability of oestradiol patches as of 9 December 2022: 25 mcg:
Limited Estradot (pharmacode 2358840) is available, further stock is expected mid-Dec 22
Estraderm MX (pharmacode 2645475) is available
50 mcg:
75 mcg:
Limited Estradot (pharmacode 2358867) is available, further stock is expected early Jan 23
Estradiol TDP Mylan (pharmacode 2601591) is available
Limited Estradot (pharmacode 2514346) is available). Further stock is expected early Feb 23
Estradiol TDP Mylan (pharmacode 2605317) is available 100 mcg: Estradot (pharmacode 2358883) is available. Further stock is expected early Jan 23
The alternative brands listed are not Medsafe-approved, as such they need to be prescribed and dispensed in line with Section 29 of the Medicines Act
For more information, please see the Pharmac website
Cilazapril discontinuation: Update
We plan to delist cilazapril mid-2023. Currently cilazapril is used in New Zealand more than in any other country, and there is only one place in the world that makes the active ingredient. This means if there were a supply issue, it would be difficult for us to be able to find an alternative for everyone who takes it.
Ramipril, another angiotensin converting enzyme (ACE) inhibitor used to treat hypertension, heart failure, diabetic renal disease and post myocardial infarction, has been funded from 1 December 2022. Ramipril will be funded with no restrictions.
Perindopril 8 mg tablets have also been added to the Pharmaceutical Schedule with no restrictions from 1 October 2022, providing an opportunity for effective treatment with one tablet once a day.
We encourage prescribers to start transitioning patients currently on cilazapril to alternative treatments as soon as practical.
Resources for prescribers:
- Changing ACEs: The new line up – advice for prescribers including dose equivalence charts
- Switching blood pressure medications – it’s time to break the cilazapril habit - He Ako Hiringa
- Read BPAC’s advice on prescribing ACE inhibitors
- Read about treating hypertension and heart failure in the NZ Formulary
- Read advice from Dr Richard Medlicott, former Medical Director of the Royal New Zealand College of General Practitioners
Further information about this discontinuation and anticipated timeframes is available on our website
Laxatives: Supply issues
There are supply issues affecting a number of laxatives
Viatris has advised that there is a supply issue with Konsyl-D. Resupply is expected in January 2023.
Pharmac has looked at other options as alternatives, however we have been unable to find a suitable option that can fulfil the demand for psyllium husk-based products.
For further information please visit the Pharmac website.
Accuretic (quinapril and hydrochlorothiazide) tablets: supply issue
Pfizer has issued a recall notice for all remaining stock of Accuretic. We will delist Accuretic toward the start of 2023.
Further information is available on the Pharmac website.
COVID-19: Information for prescribers
Current Access Criteria for antivirals
Check the Pharmac website to view the COVID-19 access criteria. Always check the criteria before prescribing as updates may have been made.
Pharmac website – COVID-19 oral antivirals: Access Criteria
You can read all about the available, and soon to be available, COVID-19 treatments on our website.
Aotearoa's COVID-19 treatment portfolio
COVID-19 antiviral Access Criteria assessment tool
Use the online tool to help identify who’s eligible for funded COVID-19 antiviral treatments.
Access Criteria Assessment Tool
Managing supply of other medications
Please prescribe normally and encourage patients not to stockpile medicines.
Pharmac, pharmacies and suppliers are working closely to maintain medicines supply, and to minimise disruption and fairly distribute any medicines in short supply.
More information about Pharmac’s response to COVID-19 is available on the Pharmac website.
Nutricia foods products: Supply issue affecting multiple products
Most of the supply issues affecting Nutricia special foods products have been resolved. There will however continue to be supply issues for some products throughout 2022. Please do not make prescriptions brand and/or flavour specific. This will allow flexibility for pharmacists when dispensing.
Check the Pharmac website regularly for updates on products.
We want you! Expressions of Interest for Pharmac’s Advisory Committees
Pharmac is looking for new members for our Advisory Committees. Do you work in primary care and bring a commitment to and understanding of te Tiriti in healthcare? We are particularly seeking to appoint General Practitioners to a number of our Advisory Committees to provide input from the primary care perspective.
Pharmac’s Advisory Committees provide us with specialist knowledge and expertise within specific clinical areas, such as diabetes, cancer, and mental health. Advisory Committees usually meet once a year, but maybe more or less frequently. You can find more information about Advisory Committees roles and responsibilities on the Pharmac website
If you are interested in being involved in Pharmac’s clinical advice network, please send an email to advisorycommittees@pharmac.govt.nz letting us know your specific clinical area(s) of interest.