Prescriber Updates

These prescriber updates provide primary care clinicians with clinical resources, overviews of upcoming new medicines, updates to clinical practice or guidelines and alerts. 

Long-term gout management | July 2026

This month, we will focus only on the long-term management of gout; for flare treatment, please refer to HealthPathways.

Once gout is diagnosed, urate-lowering treatment should be discussed and initiated early, including during an acute flare if appropriate.

Start urate-lowering treatment in patients with symptomatic hyperuricemia and any of the following:

• Two or more flares per year (including if self-managed)

• Tophi or erosions/damage on X-ray 

• Renal impairment (eGFR < 60 mL/min/1.73 m2) 

•  History of kidney stones (nephrolithiasis)

• Early-onset gout, e.g. aged < 40 years; the average age of onset is significantly lower for Māori (39 years) and Pacific peoples (33.5 years) compared to New Zealand Europeans (46.5 years)

• Very high serum urate levels, e.g. ≥ 0.6 mmol/L

• High risk of severe gout when there is strong family history of the condition

Note: Urate-lowering medicines are not indicated for asymptomatic hyperuricemia.

Use a treat-to-target-urate approach

·         < 0.36 mmol/L – for most patients; or

·         < 0.30 mmol/L – for patients with severe gout, e.g. those with tophi, chronic gouty arthritis or frequent flares

Measure serum urate monthly to guide dose adjustment until target is reached, then every 6–12 months to ensure it is maintained.

Allopurinol is used as first-line treatment

The starting dose is based on the patient’s renal function and should be increased slowly, with titration guided by serum urate levels to achieve the target dose to reduce risk of flares and adverse effects.

Allopurinol is generally well tolerated, but patients should be warned about rare severe hypersensitivity reactions and advised to stop treatment and seek review if a rash develops, particularly within the first six weeks.

Note: Consider HLA–B*5801 screening before starting allopurinol in some Asian subpopulations due to the risk of severe hypersensitivity reactions.

Other urate-lowering medicines are available for patients who are unable to tolerate allopurinol or are unable to reach their serum urate target with allopurinol alone, including probenecid or febuxostat, used according to patient comorbidities and renal function.

Gout flare prophylaxis recommended at initiation of urate-lowering treatment 

• Rapid urate reduction early in urate-lowering therapy can trigger acute gout flares.

• Prophylaxis is recommended for the first 3–6 months and may be reviewed at 3 months if the patient is symptom-free with a substantial reduction in serum urate.

Gout and blood pressure prescribing hints

•  Thiazides and loop diuretics can increase serum urate levels

•  Losartan has a modest uricosuric effect, is a helpful adjunct to urate-lowering therapy.

Further Information

Gout - HealthPathways

Overcoming gout - bpacnz

Upcoming HbA1c changes | June 2026

From the 1^st of July 2026, HbA1c diagnostic thresholds for diabetes and prediabetes are changing. This aligns with international best practice and supports earlier diagnosis and intervention.

Updated HbA1c thresholds

• Normal: < 42 mmol/mol

• Prediabetes: 42 – 47 mmol/mol

• Diabetes: ≥ 48 mmol/mol
  
  

Confirmatory testing

·         Required as soon as practical if HbA1c 48 – 52 mmol/mol.

·         Not required if:

o   HbA1c ≥ 53 mmol/mol,

o   2 or more HbA1c results ≥ 48 mmol/mol in the past 12 months, or

o   Glucose diagnostic criteria are met.

Key points

• Review of affected patients can occur as part of routine care unless earlier assessment is clinically indicated.

• Recommended management of prediabetes and type 2 diabetes remains the same.

• No change to the glucose diagnostic criteria for diabetes.

• For newly diagnosed diabetics, first retinal screening may be deferred for 3 years if evidence of recent onset (e.g. HbA1c < 48 mmol/mol in the past 12 months), unless clinically indicated.
  
  

Thalamus diabetes dashboard

Updated to support proactive identification of affected patients:

• Uncoded diabetics: patients meeting new diagnostic criteria without a diabetes code.

• Unconfirmed diabetics: patients requiring a confirmatory HbA1c test.

The dashboard can also be used to identify patients overdue for their diabetic annual review (DAR), foot checks, or HbA1c test.

Diabetes Dashboard

Lifestyle changes remain essential for diabetes management

Support to offer patients include:

• Health coaches

• Health improvement practitioners (HIPs)

• Dietitians

•  Green Prescription

• WellSouth programmes:

o   Take control of your diabetes

o   Walking away (prediabetes)

Further Information

Laboratory reporting, HealthPathways and NZ Society for the Study of Diabetes (NZSSD) guidance will be updated to reflect these changes.

·       

Medicine Supply Issues | May 2026

Medicine supply disruptions are an ongoing global challenge, with availability changing frequently. Staying up to date can be difficult.

PHARMAC maintains a regularly updated Medicine Notices webpage outlining current supply issues, discontinuations and brand changes. We recommend bookmarking this page for quick access.

You can also subscribe to PHARMAC’s email updates for health care professionals to receive regular information about consultations, notifications, and supply issues.

Other considerations

Recent updates to the Medicines Act 1981 provide additional flexibility during shortages. Under Section 29A, any authorised prescriber may prescribe an unapproved medicine that is funded by PHARMAC as an alternative to an approved medicine in short supply.

Stock availability may vary between pharmacies. Liaising with local pharmacists can help identify suitable alternatives and provide up-to-date information on availability.  

For specific concerns about medicine supply issues, enquiries can be directed to PHARMAC.

Clinical or drug information enquiries can be directed to our WellSouth Pharmacists.