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[post_content] => Patients often find creative ways to remember to take their medicines. These might include alarms and reminder apps or placing medicines in visible locations like kitchen benches or
bedside tables. However, some patients remove medicines from their original packaging to make their medication routine more convenient.
They might transfer them into pill organisers, plastic bags or leave them loose in pockets or
handbags. While these strategies may help with adherence, they can also compromise
medicine stability and effectiveness.1
Challenges of repackaging medicines
While manufacturers test the stability of medicines in original packaging, this assurance of stability over the shelf life is lost once medicines are removed from the original packaging.2,3
A national study of community pharmacists found that 88% had observed visible changes
in repackaged medicines, including discolouration, softening and enteric coat rupture. These changes were most frequently reported in humid and hot climates.1
In these high-risk climates, sodium valproate, telmisartan, and aspirin were found to be particularly susceptible to physical instability.1
Patient storage practices: a critical factor
Despite pharmacist recommendations, patients may unknowingly compromise their medicines’ safety by exposing them to heat, moisture or light, leading to degradation and reduced effectiveness. Common storage locations (e.g. bathroom cabinet, car) can contribute to degradation.
For instance, enteric-coated tablets, designed to resist stomach acid, were found to rupture prematurely when exposed to moisture. Softening of tablets and capsules was also frequently noted, leading to crumbling or loss of integrity. These changes can compromise drug efficacy and patient safety, particularly for medicines with a narrow therapeutic index.4
Best practices for medicine storage at home
To maintain medicine stability and effectiveness, patients should follow key storage principles:
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[post_content] => A recent report conducted by the Coroners Court of Victoria found that overdose deaths in 2024 were the highest they have been in a decade.
And of the 584 Victorians who died of an overdose last year, a stark proportion were related to illegal drugs, said Associate Professor Shalini Arunogiri, NHMRC Emerging Leader Research Fellow at Monash Addiction Research Centre and Eastern Health Clinical School.
‘A decade ago, they accounted for less than 50% of overdose deaths. But in 2024, that contribution is now 65% – with a year-on-year increase in the last few years.’
A significant contributor to this trend is the increase in heroin-related deaths, with 248 deaths in the last year compared to 204 in 2023.
‘There has also been a significant increase in the number of methamphetamine-related deaths – which have tripled over the last decade [to 215 deaths],’ A/Prof Arunogiri said.
A sub-analysis of the report, looking at accidental versus intentional overdose, found the vast majority (75%) of deaths were accidental. Men aged 35–54 were also most at risk, as are those who live in urban areas – with three-quarters of deaths occurring in metropolitan Melbourne.
‘[But] in the cases where it was thought to be intentional, women are over-represented in that group,’ she said.
What’s driving these trends?
A good indicator is understanding who’s accessing treatment, A/Prof Arunogiri said.
‘We have treatment-specific data that we can compare and contrast with, and then we also have national survey data,’ she said.
‘From both those sources, what we see is a high proportion of the opioid-related [treatment] cases are prescription opioids’.
In other words, those accessing opioid replacement therapy (ORT) are more likely to be patients who use prescription, rather than illegal, opioids – leaving the latter more susceptible to overdose.
‘We've seen extended waits for people to access prescribing and treatment in the Victorian setting,’ she said. ‘It’s a concerning trend to see a rise in heroin-related deaths because people are not able to get into treatment quickly for opioids at the moment.’
Another potential contributor to overdose deaths linked to illegal drugs is contaminants in the supply – including novel synthetic opioids such as nitazenes. However, we won’t know the impact of this straight away, A/Prof Arunogiri said.
‘This is a very quickly emerging trend,’ she said. ‘With the most recent data on [this] report being the full year of 2024, it might not reflect exactly what we're seeing on the ground just yet. But we'd be expecting that in the next year of data there will be a potential escalation in those deaths.’
What role is prescribing playing?
Since 2020, there has been a downturn in the number of overdose deaths related to pharmaceutical opioids.
This could be because opioid prescribing in Australia decreased by 21% between 2015 and 2022, driven by a series of regulatory and policy changes. This includes the tightening of prescribing rules in June 2020, which set limits on repeat scripts, mandated smaller pack sizes for immediate-release opioids and increased requirements for prescriber authorisation.
However, Australia still ranks among the top countries in per-capita opioid prescribing, with opioids remaining the primary cause of drug-induced deaths. And Victoria’s real-time prescription monitoring system, SafeScript, doesn't appear to be reducing high-risk opioid prescribing.
A 2023 study found that there was no significant impact on the prescribing of high-dose opioids or high‑risk combinations such as opioids with benzodiazepines or pregabalin. Instead, reductions occurred in low‑dose opioid prescribing. And at the same time, there was evidence of unintended substitution effects, with increased initiation of medicines such as tricyclic antidepressants, pregabalin and tramadol.
While not a major contributor to annual overdose deaths, the number of pregabalin-related deaths have risen – reaching 92 in 2024, versus 34 in 2015.
With gabapentinoids (pregabalin and gabapentin) and tramadol added to SafeScript 2 years ago, A/Prof Arunogiri said it will be interesting to see what occurs in this space.
‘We particularly want to keep an eye on pregabalin-related deaths,’ she said.
What are the bottlenecks to ORT access?
Reforms to Pharmaceutical Benefits Scheme (PBS) Opioid Dependence Treatment (ODT) medicine arrangements have widened access to treatment by improving affordability.
But in Victoria, the vast majority of ORT prescribing occurs within general practice settings rather than public sector settings, A/Prof Arunogiri said.
‘So the block, rather than being a dispensing issue, is on the prescribing end – with the waits to get into treatment increasing over time,’ she said.
‘When prescribers retire, there’s a huge bottleneck preventing people from getting into treatment, because it's such a small prescribing pool in the state.’
Within Victoria, there's been significant advocacy for systemic reform of the opioid pharmacotherapy system to reduce wait times and increase public sector involvement.
Shared-care involvement in ORT programs should help to improve access and engagement with therapy.
‘There are novel pharmacy shared care models that are starting to be trialled,’ A/Prof Arunogiri said.
‘This supports pharmacists' involvement, not just at the dispensing end, but also in prescribing – including working with local GPs in a model that enables expanded access to medication.’
Across the country, the message appears to be getting through about ODT for people who are dependent on prescription opioids.
‘This is a growing proportion of our population. In some settings, more than 50% of our client group is prescription opioid dependent,’ she said.
What else needs to change?
An engagement and expansion of Take Home Naloxone (THN) programs – not just in Victoria, but nationally.
Within Victoria, an investment in expanding access to THN is already occurring.
‘We're looking at a trial of vending machines to be able to dispense THN,’ A/Prof Arunogiri said.
Located at health services such as community health centres and hospitals in Melbourne's central business district and inner suburbs, the vending machines are proposed to provide free naloxone and must maintain medicine stability.
‘If pharmacists can be engaged in that process, and promote and advertise awareness of THN – that will be a huge help in preventing these overdoses,’ she said.
Where possible, pharmacies should stock both intranasal and injectable THN formulations.
‘This can help to demystify the process for the lay public, who may be less comfortable administering an injectable product,’ she A/Prof Arunogiri said.
Promoting understanding that naloxone is a safe substance that’s life-saving when administered to someone experiencing an overdose, is also key.
‘We're also really advocating for awareness of THN for people who are prescribed opioids,’ A/Prof Arunogiri said. ‘If you're prescribed an opioid analgesic, you should have access to THN – that's anyone who has hip or back pain, or is prescribed strong opioids for these types of indications.’
Some people have raised concerns about giving naloxone to an unconscious person who may not be experiencing an opioid overdose.
‘But there's no risk; naloxone also won’t interact with anything aside from opioids,’ A/Prof Arunogiri said.
To enhance clinical outcomes and medication safety for people using prescription opioids for chronic pain, access the Opioid Safety Toolkit – co-developed by PSA, Monash University and PainAustralia – which includes an opioid safety plan template, consumer-facing posters and Routine Opioid Outcomes Monitoring templates.
[post_title] => Overdose deaths hit decade-high in Victoria
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[post_content] => Yesterday (19 August), it was announced that Ozempic (semaglutide 1.0 mg) has received approval from the Therapeutic Goods Administration (TGA) for an expansion of indication to reduce the risk of kidney disease progression in patients with type 2 diabetes and chronic kidney disease (CKD).
It’s estimated that around 2.7 million Australians are living with indicators of CKD, including both diagnosed and undiagnosed cases.
Of these, diabetes is the leading cause of end stage kidney disease (ESKD) – accounting for over a third (38%) of new cases. Of an estimated 333,000 Australians living with both CKD and diabetes, approximately 10,000 are expected to progress to kidney failure.
If not managed appropriately and in serious cases, CKD may also lead to kidney failure, heart disease and stroke, and in some cases, premature death, said Professor Vlado Perkovic, nephrologist and Provost at the University of New South Wales.
‘Early intervention can help with slowing disease progression,’ he said.
‘This approval represents a step forward in addressing the multifaceted needs of individuals living with type 2 diabetes and CKD,’ added Dr Ana Svensson, Vice President of Clinical, Medical and Regulatory at Novo Nordisk Oceania.
What does the evidence say?
The FLOW (Evaluate Renal Function with Semaglutide Once Weekly) trial is a large multinational study that assessed the effects of once-weekly semaglutide 1.0 mg in adults with type 2 diabetes and CKD.
Participants who received semaglutide had a 24% reduction in risk of major kidney events, slower decline in estimated glomerular filtration rate, and decreased albuminuria – compared to placebo. They also experienced improvements in cardiovascular outcomes and all-cause mortality – with the safety profile consistent with previous studies.
To date, the TGA has not released specific dosing guidance related to the new CKD indication.
Will Ozempic be PBS listed for CKD?
Semaglutide (Ozempic) for CKD is currently not subsidised under the Pharmaceutical Benefits Scheme (PBS).
That means the out-of-pocket costs will not be subsidised, compared to around $31.60 for general patients using the medicine under existing PBS criteria.
‘While it is not specifically reimbursed for kidney disease risk reduction, Novo Nordisk continues to engage with government stakeholders to explore opportunities for broader access to our medicines for Australians living with chronic conditions,’ a spokesperson for Novo Nordisk told Australian Pharmacist.
With Ozempic no longer in shortage, will access open up?
Last month (18 July), the TGA officially removed Ozempic from its medicine shortages list, with previous supply restrictions now lifted. Now that Ozempic stocks have returned to a sufficient level, new patients can be initiated on the medicine. But Ozempic prescribed for weight loss is still off-label, with no update to the indication for weight loss. So the PBS criteria on this front also remain unchanged, and it’s uncertain if this will change any time soon.
‘We have semaglutide 2.4 mg (Wegovy) available – it is indicated for the treatment of patients with obesity or overweight and established cardiovascular disease,’ the Novo Nordisk spokesperson said.
But experts hope that subsidy and accessibility will improve over time as demand and evidence grow.
‘There’s no doubt that both cost and availability present a barrier to the more widespread use of semaglutide at the moment,’ Prof Perkovic said. ‘But I’m sure that over time that situation will change and the drugs will become more widely available.’
[post_title] => Ozempic now indicated to prevent CKD progression
[post_excerpt] => Ozempic is the first medicine in Australia approved to slow kidney disease progression in patients with both type 2 diabetes and CKD.
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[post_content] => This national resource supports frontline assessment, management and prompt referral of burn injuries.
Community pharmacists are often the first point of contact for health concerns and public health initiatives, including burns, said Rebecca Schrale, Burns Nurse Practitioner at the Royal Hobart Hospital’s Burns Unit and Australian and New Zealand Burn Association (ANZBA) Burns Prevention Representative for Tasmania.
‘[So] community pharmacists are in a unique position to provide education on initial first aid, referral and wound care,’ she said. ‘They also have an important role in prevention of burn injuries, educating the community and reducing risk.’
To that end, ANZBA, PSA and the National Australian Pharmacy Students’ Association (NAPSA) collaborated to develop guidelines specifically for pharmacists to assist with the assessment and management of burns.
Australian Pharmacist investigates what pharmacists should look out for and how to manage and refer burns appropriately.
What burns do community pharmacists typically encounter?
The full spectrum – from minor to severe, said PSA Tasmania State Manager Dr Ella van Tienen FPS.
‘A lot of it is advice for minor sunburn or small burns,’ she said. ‘But you do get some more serious burns when people aren’t sure what to do with them, or whether they’re serious enough to [require further attention].’
Burns are more likely to occur out of hours, such as on weekends and public holidays – particularly among children – when general practices are typically closed.
‘That’s when kids are home,’ Dr van Tienen added.
Common causes of burns in children include hot water scalds due to access to kettles or stove tops.
‘Teenagers who are newly independent and off at the beach on their own, also present with blistering sunburn,’ she said.
What impact do burns have on the community?
It’s important to remember that even minor burns can have long-term effects on the patient in regard to range of movement, function and the look and feel of the scar, Ms Schrale said.
‘All burn injuries – whether large or small can have a psychological effect on the individual and their family,’ she said. ‘And it’s imperative that patients are referred to burns clinicians in a timely manner.’
Deep burn injuries will result in scarring and could restrict the function of the area that is affected.
‘Pharmacies are often open after hours and on weekends so again they provide clients and their families with timely advice, education and support,’ Ms Schrale said.
What does the burns resource involve?
The new Pharmacists Advisory Card and A3 Poster are new iterations of an old resource, Dr van Tienen said.
‘The original resource had been around for many years, and it needed to be updated,’ she said.
The refreshed burns advisory resource provides pharmacists with up-to-date information on Burns First Aid, and assessment – including burn depth, assessment and minor burn wound care, Ms Schrale said.
‘With this knowledge they are equipped to then follow the ANZBA referral guidelines, highlighting who requires discussion or referral to primary [care] or the local emergency department (ED),’ she said. ‘The updated card ensures the messaging is consistent across pharmacies, community health, primary care and EDs nationally.’
What new information is included?
The new version of the card focuses on information that will assist in early assessment, management and referral of minor burns, Ms Schrale said.
‘It also provides simple and consistent messaging on wound care and medical emergencies – such as large surface area burns, airway burns, circumferential burns and infection,’ she said.
‘The other new addition is the inclusion of information on burns scar management based on evidence-based practice and encouraging referral for any patient who sustains a scar from a burn injury.’
How can the burns resource be used in practice?
Let’s say a parent presents to the pharmacy with a child who has sustained a burn after accidentally knocking over a pot of boiling water while cooking pasta on the stove.
‘If the child has a small [dermal] burn that’s not significantly blistered, the pharmacist could appropriately treat it in the community by providing first aid and dressing advice,’ Dr van Tienen said.
‘The pharmacist should advise the parent to watch out for [significant] blistering, the blisters breaking, any signs of infection or excessive [levels] of pain.’
Indicators that should prompt further action include if the child:
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[post_content] => Too many people are taking way too much Vitamin B6. Here are the risks of high doses and how the Therapeutic Goods Administration (TGA) is responding.
What is the concern about Vitamin B6?
High doses and/or prolonged use of Vitamin B6 above the recommended daily intake (RDI) have been linked to peripheral neuropathy. Most cases have been reported at doses exceeding 500 mg/day, although cases at lower doses have been reported.1
The TGA’s adverse events notification database contains 174 reports1 of peripheral neuropathy, peripheral sensory neuropathy, small fibre neuropathy or chronic polyneuropathy for products containing Vitamin B6.1
The primary concern is the risk of overconsumption of Vitamin B6 from a variety of sources, particularly in individuals using multiple multivitamin and supplement products.1
How many products have Vitamin B6 in them?
Lots! There are over 1,500 products listed on the Australian Register of Therapeutic Goods (ARTG) which contain Vitamin B6. Approximately 100 of these products have more than 50 mg of Vitamin B6 as the single active ingredient.
The inclusion of Vitamin B6 in these products is rarely prominently displayed. And labelling of Vitamin B6 is often not visible to or understood by consumers, instead being referenced as pyridoxine, pyridoxine hydrochloride, pyridoxal 5-phosphate and pyridoxal 5-phosphate monohydrate.1
What is the TGA doing?
The TGA Delegate has made an interim decision to amend the scheduling of medicines containing more than 50 mg of Vitamin B6 but less than 200 mg (per recommended daily dose) to classify them as Pharmacist Only Medicines (Schedule 3).
If the TGA Delegate’s interim decision is confirmed, the schedule changes will take effect on 1 February 2027.
What should pharmacists do differently?
Ensure all consumers are asked if they are taking multiple vitamin or mineral supplements every time a Vitamin B6-containing product is requested or supplied. Where this is the case, it’s important to consider total Vitamin B6 dose, including dietary sources, and ensure it does not exceed 200 mg daily.
Pharmacists should also warn of early signs of neuropathy, such as tingling, burning or numbness – and advise they cease the medicine and seek medical review if this occurs.
Should pharmacists still supply Vitamin B6 for use in pregnancy?
There are a couple of different treatment regimens for pyridoxine (Vitamin B6) tablets for nausea and vomiting of pregnancy which involve divided doses.2–4 Some references caution against quality of evidence and modest benefit.
The maximum daily dose should not exceed 200 mg. This upper dose is generally considered to be safe for the duration of pregnancy.
References
- Australian Government Department of Health, Disability and Ageing. Therapeutic Goods Administration. Notice of interim decision to amend (or not amend) the current Poisons Standard in relation to pyridoxine, pyridoxal or pyridoxamine (vitamin B6). 2025. At: www.tga.gov.au/sites/default/files/2025-06/notice-interim-decision-amend-or-not-amend-current-poisons-standard-pyridoxine-pyridoxal-pyridoxamine-vitaminb6.pdf
- Therapeutic Guidelines: Nausea and vomiting during pregnancy. 2025. At: www.tg.org.au
- Government of Western Australia. North Metropolitan Health Service Women and Newborn Health Service. Pyridoxine (Vitamin B6). 2024. At: www.kemh.health.wa.gov.au/~/media/HSPs/NMHS/Hospitals/WNHS/Documents/Clinical-guidelines/Obs-Gyn-MPs/Pyridoxine---Vitamin-B6.pdf?thn=0
- Safer Care Victoria. Medications to treat hyperemesis. 2025. At: www.safercare.vic.gov.au/best-practice-improvement/clinical-guidance/maternity/nausea-and-vomiting#goto-table1.-medications-to-treat-hyperemesis
[post_title] => How pharmacists should address rising B6 overuse
[post_excerpt] => Too many people are taking way too much Vitamin B6. A senior pharmacist explains the risks of high doses, and how the TGA is responding.
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[post_content] => Patients often find creative ways to remember to take their medicines. These might include alarms and reminder apps or placing medicines in visible locations like kitchen benches or
bedside tables. However, some patients remove medicines from their original packaging to make their medication routine more convenient.
They might transfer them into pill organisers, plastic bags or leave them loose in pockets or
handbags. While these strategies may help with adherence, they can also compromise
medicine stability and effectiveness.1
Challenges of repackaging medicines
While manufacturers test the stability of medicines in original packaging, this assurance of stability over the shelf life is lost once medicines are removed from the original packaging.2,3
A national study of community pharmacists found that 88% had observed visible changes
in repackaged medicines, including discolouration, softening and enteric coat rupture. These changes were most frequently reported in humid and hot climates.1
In these high-risk climates, sodium valproate, telmisartan, and aspirin were found to be particularly susceptible to physical instability.1
Patient storage practices: a critical factor
Despite pharmacist recommendations, patients may unknowingly compromise their medicines’ safety by exposing them to heat, moisture or light, leading to degradation and reduced effectiveness. Common storage locations (e.g. bathroom cabinet, car) can contribute to degradation.
For instance, enteric-coated tablets, designed to resist stomach acid, were found to rupture prematurely when exposed to moisture. Softening of tablets and capsules was also frequently noted, leading to crumbling or loss of integrity. These changes can compromise drug efficacy and patient safety, particularly for medicines with a narrow therapeutic index.4
Best practices for medicine storage at home
To maintain medicine stability and effectiveness, patients should follow key storage principles:
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[post_content] => A recent report conducted by the Coroners Court of Victoria found that overdose deaths in 2024 were the highest they have been in a decade.
And of the 584 Victorians who died of an overdose last year, a stark proportion were related to illegal drugs, said Associate Professor Shalini Arunogiri, NHMRC Emerging Leader Research Fellow at Monash Addiction Research Centre and Eastern Health Clinical School.
‘A decade ago, they accounted for less than 50% of overdose deaths. But in 2024, that contribution is now 65% – with a year-on-year increase in the last few years.’
A significant contributor to this trend is the increase in heroin-related deaths, with 248 deaths in the last year compared to 204 in 2023.
‘There has also been a significant increase in the number of methamphetamine-related deaths – which have tripled over the last decade [to 215 deaths],’ A/Prof Arunogiri said.
A sub-analysis of the report, looking at accidental versus intentional overdose, found the vast majority (75%) of deaths were accidental. Men aged 35–54 were also most at risk, as are those who live in urban areas – with three-quarters of deaths occurring in metropolitan Melbourne.
‘[But] in the cases where it was thought to be intentional, women are over-represented in that group,’ she said.
What’s driving these trends?
A good indicator is understanding who’s accessing treatment, A/Prof Arunogiri said.
‘We have treatment-specific data that we can compare and contrast with, and then we also have national survey data,’ she said.
‘From both those sources, what we see is a high proportion of the opioid-related [treatment] cases are prescription opioids’.
In other words, those accessing opioid replacement therapy (ORT) are more likely to be patients who use prescription, rather than illegal, opioids – leaving the latter more susceptible to overdose.
‘We've seen extended waits for people to access prescribing and treatment in the Victorian setting,’ she said. ‘It’s a concerning trend to see a rise in heroin-related deaths because people are not able to get into treatment quickly for opioids at the moment.’
Another potential contributor to overdose deaths linked to illegal drugs is contaminants in the supply – including novel synthetic opioids such as nitazenes. However, we won’t know the impact of this straight away, A/Prof Arunogiri said.
‘This is a very quickly emerging trend,’ she said. ‘With the most recent data on [this] report being the full year of 2024, it might not reflect exactly what we're seeing on the ground just yet. But we'd be expecting that in the next year of data there will be a potential escalation in those deaths.’
What role is prescribing playing?
Since 2020, there has been a downturn in the number of overdose deaths related to pharmaceutical opioids.
This could be because opioid prescribing in Australia decreased by 21% between 2015 and 2022, driven by a series of regulatory and policy changes. This includes the tightening of prescribing rules in June 2020, which set limits on repeat scripts, mandated smaller pack sizes for immediate-release opioids and increased requirements for prescriber authorisation.
However, Australia still ranks among the top countries in per-capita opioid prescribing, with opioids remaining the primary cause of drug-induced deaths. And Victoria’s real-time prescription monitoring system, SafeScript, doesn't appear to be reducing high-risk opioid prescribing.
A 2023 study found that there was no significant impact on the prescribing of high-dose opioids or high‑risk combinations such as opioids with benzodiazepines or pregabalin. Instead, reductions occurred in low‑dose opioid prescribing. And at the same time, there was evidence of unintended substitution effects, with increased initiation of medicines such as tricyclic antidepressants, pregabalin and tramadol.
While not a major contributor to annual overdose deaths, the number of pregabalin-related deaths have risen – reaching 92 in 2024, versus 34 in 2015.
With gabapentinoids (pregabalin and gabapentin) and tramadol added to SafeScript 2 years ago, A/Prof Arunogiri said it will be interesting to see what occurs in this space.
‘We particularly want to keep an eye on pregabalin-related deaths,’ she said.
What are the bottlenecks to ORT access?
Reforms to Pharmaceutical Benefits Scheme (PBS) Opioid Dependence Treatment (ODT) medicine arrangements have widened access to treatment by improving affordability.
But in Victoria, the vast majority of ORT prescribing occurs within general practice settings rather than public sector settings, A/Prof Arunogiri said.
‘So the block, rather than being a dispensing issue, is on the prescribing end – with the waits to get into treatment increasing over time,’ she said.
‘When prescribers retire, there’s a huge bottleneck preventing people from getting into treatment, because it's such a small prescribing pool in the state.’
Within Victoria, there's been significant advocacy for systemic reform of the opioid pharmacotherapy system to reduce wait times and increase public sector involvement.
Shared-care involvement in ORT programs should help to improve access and engagement with therapy.
‘There are novel pharmacy shared care models that are starting to be trialled,’ A/Prof Arunogiri said.
‘This supports pharmacists' involvement, not just at the dispensing end, but also in prescribing – including working with local GPs in a model that enables expanded access to medication.’
Across the country, the message appears to be getting through about ODT for people who are dependent on prescription opioids.
‘This is a growing proportion of our population. In some settings, more than 50% of our client group is prescription opioid dependent,’ she said.
What else needs to change?
An engagement and expansion of Take Home Naloxone (THN) programs – not just in Victoria, but nationally.
Within Victoria, an investment in expanding access to THN is already occurring.
‘We're looking at a trial of vending machines to be able to dispense THN,’ A/Prof Arunogiri said.
Located at health services such as community health centres and hospitals in Melbourne's central business district and inner suburbs, the vending machines are proposed to provide free naloxone and must maintain medicine stability.
‘If pharmacists can be engaged in that process, and promote and advertise awareness of THN – that will be a huge help in preventing these overdoses,’ she said.
Where possible, pharmacies should stock both intranasal and injectable THN formulations.
‘This can help to demystify the process for the lay public, who may be less comfortable administering an injectable product,’ she A/Prof Arunogiri said.
Promoting understanding that naloxone is a safe substance that’s life-saving when administered to someone experiencing an overdose, is also key.
‘We're also really advocating for awareness of THN for people who are prescribed opioids,’ A/Prof Arunogiri said. ‘If you're prescribed an opioid analgesic, you should have access to THN – that's anyone who has hip or back pain, or is prescribed strong opioids for these types of indications.’
Some people have raised concerns about giving naloxone to an unconscious person who may not be experiencing an opioid overdose.
‘But there's no risk; naloxone also won’t interact with anything aside from opioids,’ A/Prof Arunogiri said.
To enhance clinical outcomes and medication safety for people using prescription opioids for chronic pain, access the Opioid Safety Toolkit – co-developed by PSA, Monash University and PainAustralia – which includes an opioid safety plan template, consumer-facing posters and Routine Opioid Outcomes Monitoring templates.
[post_title] => Overdose deaths hit decade-high in Victoria
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[post_content] => Yesterday (19 August), it was announced that Ozempic (semaglutide 1.0 mg) has received approval from the Therapeutic Goods Administration (TGA) for an expansion of indication to reduce the risk of kidney disease progression in patients with type 2 diabetes and chronic kidney disease (CKD).
It’s estimated that around 2.7 million Australians are living with indicators of CKD, including both diagnosed and undiagnosed cases.
Of these, diabetes is the leading cause of end stage kidney disease (ESKD) – accounting for over a third (38%) of new cases. Of an estimated 333,000 Australians living with both CKD and diabetes, approximately 10,000 are expected to progress to kidney failure.
If not managed appropriately and in serious cases, CKD may also lead to kidney failure, heart disease and stroke, and in some cases, premature death, said Professor Vlado Perkovic, nephrologist and Provost at the University of New South Wales.
‘Early intervention can help with slowing disease progression,’ he said.
‘This approval represents a step forward in addressing the multifaceted needs of individuals living with type 2 diabetes and CKD,’ added Dr Ana Svensson, Vice President of Clinical, Medical and Regulatory at Novo Nordisk Oceania.
What does the evidence say?
The FLOW (Evaluate Renal Function with Semaglutide Once Weekly) trial is a large multinational study that assessed the effects of once-weekly semaglutide 1.0 mg in adults with type 2 diabetes and CKD.
Participants who received semaglutide had a 24% reduction in risk of major kidney events, slower decline in estimated glomerular filtration rate, and decreased albuminuria – compared to placebo. They also experienced improvements in cardiovascular outcomes and all-cause mortality – with the safety profile consistent with previous studies.
To date, the TGA has not released specific dosing guidance related to the new CKD indication.
Will Ozempic be PBS listed for CKD?
Semaglutide (Ozempic) for CKD is currently not subsidised under the Pharmaceutical Benefits Scheme (PBS).
That means the out-of-pocket costs will not be subsidised, compared to around $31.60 for general patients using the medicine under existing PBS criteria.
‘While it is not specifically reimbursed for kidney disease risk reduction, Novo Nordisk continues to engage with government stakeholders to explore opportunities for broader access to our medicines for Australians living with chronic conditions,’ a spokesperson for Novo Nordisk told Australian Pharmacist.
With Ozempic no longer in shortage, will access open up?
Last month (18 July), the TGA officially removed Ozempic from its medicine shortages list, with previous supply restrictions now lifted. Now that Ozempic stocks have returned to a sufficient level, new patients can be initiated on the medicine. But Ozempic prescribed for weight loss is still off-label, with no update to the indication for weight loss. So the PBS criteria on this front also remain unchanged, and it’s uncertain if this will change any time soon.
‘We have semaglutide 2.4 mg (Wegovy) available – it is indicated for the treatment of patients with obesity or overweight and established cardiovascular disease,’ the Novo Nordisk spokesperson said.
But experts hope that subsidy and accessibility will improve over time as demand and evidence grow.
‘There’s no doubt that both cost and availability present a barrier to the more widespread use of semaglutide at the moment,’ Prof Perkovic said. ‘But I’m sure that over time that situation will change and the drugs will become more widely available.’
[post_title] => Ozempic now indicated to prevent CKD progression
[post_excerpt] => Ozempic is the first medicine in Australia approved to slow kidney disease progression in patients with both type 2 diabetes and CKD.
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[post_content] => This national resource supports frontline assessment, management and prompt referral of burn injuries.
Community pharmacists are often the first point of contact for health concerns and public health initiatives, including burns, said Rebecca Schrale, Burns Nurse Practitioner at the Royal Hobart Hospital’s Burns Unit and Australian and New Zealand Burn Association (ANZBA) Burns Prevention Representative for Tasmania.
‘[So] community pharmacists are in a unique position to provide education on initial first aid, referral and wound care,’ she said. ‘They also have an important role in prevention of burn injuries, educating the community and reducing risk.’
To that end, ANZBA, PSA and the National Australian Pharmacy Students’ Association (NAPSA) collaborated to develop guidelines specifically for pharmacists to assist with the assessment and management of burns.
Australian Pharmacist investigates what pharmacists should look out for and how to manage and refer burns appropriately.
What burns do community pharmacists typically encounter?
The full spectrum – from minor to severe, said PSA Tasmania State Manager Dr Ella van Tienen FPS.
‘A lot of it is advice for minor sunburn or small burns,’ she said. ‘But you do get some more serious burns when people aren’t sure what to do with them, or whether they’re serious enough to [require further attention].’
Burns are more likely to occur out of hours, such as on weekends and public holidays – particularly among children – when general practices are typically closed.
‘That’s when kids are home,’ Dr van Tienen added.
Common causes of burns in children include hot water scalds due to access to kettles or stove tops.
‘Teenagers who are newly independent and off at the beach on their own, also present with blistering sunburn,’ she said.
What impact do burns have on the community?
It’s important to remember that even minor burns can have long-term effects on the patient in regard to range of movement, function and the look and feel of the scar, Ms Schrale said.
‘All burn injuries – whether large or small can have a psychological effect on the individual and their family,’ she said. ‘And it’s imperative that patients are referred to burns clinicians in a timely manner.’
Deep burn injuries will result in scarring and could restrict the function of the area that is affected.
‘Pharmacies are often open after hours and on weekends so again they provide clients and their families with timely advice, education and support,’ Ms Schrale said.
What does the burns resource involve?
The new Pharmacists Advisory Card and A3 Poster are new iterations of an old resource, Dr van Tienen said.
‘The original resource had been around for many years, and it needed to be updated,’ she said.
The refreshed burns advisory resource provides pharmacists with up-to-date information on Burns First Aid, and assessment – including burn depth, assessment and minor burn wound care, Ms Schrale said.
‘With this knowledge they are equipped to then follow the ANZBA referral guidelines, highlighting who requires discussion or referral to primary [care] or the local emergency department (ED),’ she said. ‘The updated card ensures the messaging is consistent across pharmacies, community health, primary care and EDs nationally.’
What new information is included?
The new version of the card focuses on information that will assist in early assessment, management and referral of minor burns, Ms Schrale said.
‘It also provides simple and consistent messaging on wound care and medical emergencies – such as large surface area burns, airway burns, circumferential burns and infection,’ she said.
‘The other new addition is the inclusion of information on burns scar management based on evidence-based practice and encouraging referral for any patient who sustains a scar from a burn injury.’
How can the burns resource be used in practice?
Let’s say a parent presents to the pharmacy with a child who has sustained a burn after accidentally knocking over a pot of boiling water while cooking pasta on the stove.
‘If the child has a small [dermal] burn that’s not significantly blistered, the pharmacist could appropriately treat it in the community by providing first aid and dressing advice,’ Dr van Tienen said.
‘The pharmacist should advise the parent to watch out for [significant] blistering, the blisters breaking, any signs of infection or excessive [levels] of pain.’
Indicators that should prompt further action include if the child:
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[post_content] => Too many people are taking way too much Vitamin B6. Here are the risks of high doses and how the Therapeutic Goods Administration (TGA) is responding.
What is the concern about Vitamin B6?
High doses and/or prolonged use of Vitamin B6 above the recommended daily intake (RDI) have been linked to peripheral neuropathy. Most cases have been reported at doses exceeding 500 mg/day, although cases at lower doses have been reported.1
The TGA’s adverse events notification database contains 174 reports1 of peripheral neuropathy, peripheral sensory neuropathy, small fibre neuropathy or chronic polyneuropathy for products containing Vitamin B6.1
The primary concern is the risk of overconsumption of Vitamin B6 from a variety of sources, particularly in individuals using multiple multivitamin and supplement products.1
How many products have Vitamin B6 in them?
Lots! There are over 1,500 products listed on the Australian Register of Therapeutic Goods (ARTG) which contain Vitamin B6. Approximately 100 of these products have more than 50 mg of Vitamin B6 as the single active ingredient.
The inclusion of Vitamin B6 in these products is rarely prominently displayed. And labelling of Vitamin B6 is often not visible to or understood by consumers, instead being referenced as pyridoxine, pyridoxine hydrochloride, pyridoxal 5-phosphate and pyridoxal 5-phosphate monohydrate.1
What is the TGA doing?
The TGA Delegate has made an interim decision to amend the scheduling of medicines containing more than 50 mg of Vitamin B6 but less than 200 mg (per recommended daily dose) to classify them as Pharmacist Only Medicines (Schedule 3).
If the TGA Delegate’s interim decision is confirmed, the schedule changes will take effect on 1 February 2027.
What should pharmacists do differently?
Ensure all consumers are asked if they are taking multiple vitamin or mineral supplements every time a Vitamin B6-containing product is requested or supplied. Where this is the case, it’s important to consider total Vitamin B6 dose, including dietary sources, and ensure it does not exceed 200 mg daily.
Pharmacists should also warn of early signs of neuropathy, such as tingling, burning or numbness – and advise they cease the medicine and seek medical review if this occurs.
Should pharmacists still supply Vitamin B6 for use in pregnancy?
There are a couple of different treatment regimens for pyridoxine (Vitamin B6) tablets for nausea and vomiting of pregnancy which involve divided doses.2–4 Some references caution against quality of evidence and modest benefit.
The maximum daily dose should not exceed 200 mg. This upper dose is generally considered to be safe for the duration of pregnancy.
References
- Australian Government Department of Health, Disability and Ageing. Therapeutic Goods Administration. Notice of interim decision to amend (or not amend) the current Poisons Standard in relation to pyridoxine, pyridoxal or pyridoxamine (vitamin B6). 2025. At: www.tga.gov.au/sites/default/files/2025-06/notice-interim-decision-amend-or-not-amend-current-poisons-standard-pyridoxine-pyridoxal-pyridoxamine-vitaminb6.pdf
- Therapeutic Guidelines: Nausea and vomiting during pregnancy. 2025. At: www.tg.org.au
- Government of Western Australia. North Metropolitan Health Service Women and Newborn Health Service. Pyridoxine (Vitamin B6). 2024. At: www.kemh.health.wa.gov.au/~/media/HSPs/NMHS/Hospitals/WNHS/Documents/Clinical-guidelines/Obs-Gyn-MPs/Pyridoxine---Vitamin-B6.pdf?thn=0
- Safer Care Victoria. Medications to treat hyperemesis. 2025. At: www.safercare.vic.gov.au/best-practice-improvement/clinical-guidance/maternity/nausea-and-vomiting#goto-table1.-medications-to-treat-hyperemesis
[post_title] => How pharmacists should address rising B6 overuse
[post_excerpt] => Too many people are taking way too much Vitamin B6. A senior pharmacist explains the risks of high doses, and how the TGA is responding.
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[post_content] => Patients often find creative ways to remember to take their medicines. These might include alarms and reminder apps or placing medicines in visible locations like kitchen benches or
bedside tables. However, some patients remove medicines from their original packaging to make their medication routine more convenient.
They might transfer them into pill organisers, plastic bags or leave them loose in pockets or
handbags. While these strategies may help with adherence, they can also compromise
medicine stability and effectiveness.1
Challenges of repackaging medicines
While manufacturers test the stability of medicines in original packaging, this assurance of stability over the shelf life is lost once medicines are removed from the original packaging.2,3
A national study of community pharmacists found that 88% had observed visible changes
in repackaged medicines, including discolouration, softening and enteric coat rupture. These changes were most frequently reported in humid and hot climates.1
In these high-risk climates, sodium valproate, telmisartan, and aspirin were found to be particularly susceptible to physical instability.1
Patient storage practices: a critical factor
Despite pharmacist recommendations, patients may unknowingly compromise their medicines’ safety by exposing them to heat, moisture or light, leading to degradation and reduced effectiveness. Common storage locations (e.g. bathroom cabinet, car) can contribute to degradation.
For instance, enteric-coated tablets, designed to resist stomach acid, were found to rupture prematurely when exposed to moisture. Softening of tablets and capsules was also frequently noted, leading to crumbling or loss of integrity. These changes can compromise drug efficacy and patient safety, particularly for medicines with a narrow therapeutic index.4
Best practices for medicine storage at home
To maintain medicine stability and effectiveness, patients should follow key storage principles:
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[post_content] => A recent report conducted by the Coroners Court of Victoria found that overdose deaths in 2024 were the highest they have been in a decade.
And of the 584 Victorians who died of an overdose last year, a stark proportion were related to illegal drugs, said Associate Professor Shalini Arunogiri, NHMRC Emerging Leader Research Fellow at Monash Addiction Research Centre and Eastern Health Clinical School.
‘A decade ago, they accounted for less than 50% of overdose deaths. But in 2024, that contribution is now 65% – with a year-on-year increase in the last few years.’
A significant contributor to this trend is the increase in heroin-related deaths, with 248 deaths in the last year compared to 204 in 2023.
‘There has also been a significant increase in the number of methamphetamine-related deaths – which have tripled over the last decade [to 215 deaths],’ A/Prof Arunogiri said.
A sub-analysis of the report, looking at accidental versus intentional overdose, found the vast majority (75%) of deaths were accidental. Men aged 35–54 were also most at risk, as are those who live in urban areas – with three-quarters of deaths occurring in metropolitan Melbourne.
‘[But] in the cases where it was thought to be intentional, women are over-represented in that group,’ she said.
What’s driving these trends?
A good indicator is understanding who’s accessing treatment, A/Prof Arunogiri said.
‘We have treatment-specific data that we can compare and contrast with, and then we also have national survey data,’ she said.
‘From both those sources, what we see is a high proportion of the opioid-related [treatment] cases are prescription opioids’.
In other words, those accessing opioid replacement therapy (ORT) are more likely to be patients who use prescription, rather than illegal, opioids – leaving the latter more susceptible to overdose.
‘We've seen extended waits for people to access prescribing and treatment in the Victorian setting,’ she said. ‘It’s a concerning trend to see a rise in heroin-related deaths because people are not able to get into treatment quickly for opioids at the moment.’
Another potential contributor to overdose deaths linked to illegal drugs is contaminants in the supply – including novel synthetic opioids such as nitazenes. However, we won’t know the impact of this straight away, A/Prof Arunogiri said.
‘This is a very quickly emerging trend,’ she said. ‘With the most recent data on [this] report being the full year of 2024, it might not reflect exactly what we're seeing on the ground just yet. But we'd be expecting that in the next year of data there will be a potential escalation in those deaths.’
What role is prescribing playing?
Since 2020, there has been a downturn in the number of overdose deaths related to pharmaceutical opioids.
This could be because opioid prescribing in Australia decreased by 21% between 2015 and 2022, driven by a series of regulatory and policy changes. This includes the tightening of prescribing rules in June 2020, which set limits on repeat scripts, mandated smaller pack sizes for immediate-release opioids and increased requirements for prescriber authorisation.
However, Australia still ranks among the top countries in per-capita opioid prescribing, with opioids remaining the primary cause of drug-induced deaths. And Victoria’s real-time prescription monitoring system, SafeScript, doesn't appear to be reducing high-risk opioid prescribing.
A 2023 study found that there was no significant impact on the prescribing of high-dose opioids or high‑risk combinations such as opioids with benzodiazepines or pregabalin. Instead, reductions occurred in low‑dose opioid prescribing. And at the same time, there was evidence of unintended substitution effects, with increased initiation of medicines such as tricyclic antidepressants, pregabalin and tramadol.
While not a major contributor to annual overdose deaths, the number of pregabalin-related deaths have risen – reaching 92 in 2024, versus 34 in 2015.
With gabapentinoids (pregabalin and gabapentin) and tramadol added to SafeScript 2 years ago, A/Prof Arunogiri said it will be interesting to see what occurs in this space.
‘We particularly want to keep an eye on pregabalin-related deaths,’ she said.
What are the bottlenecks to ORT access?
Reforms to Pharmaceutical Benefits Scheme (PBS) Opioid Dependence Treatment (ODT) medicine arrangements have widened access to treatment by improving affordability.
But in Victoria, the vast majority of ORT prescribing occurs within general practice settings rather than public sector settings, A/Prof Arunogiri said.
‘So the block, rather than being a dispensing issue, is on the prescribing end – with the waits to get into treatment increasing over time,’ she said.
‘When prescribers retire, there’s a huge bottleneck preventing people from getting into treatment, because it's such a small prescribing pool in the state.’
Within Victoria, there's been significant advocacy for systemic reform of the opioid pharmacotherapy system to reduce wait times and increase public sector involvement.
Shared-care involvement in ORT programs should help to improve access and engagement with therapy.
‘There are novel pharmacy shared care models that are starting to be trialled,’ A/Prof Arunogiri said.
‘This supports pharmacists' involvement, not just at the dispensing end, but also in prescribing – including working with local GPs in a model that enables expanded access to medication.’
Across the country, the message appears to be getting through about ODT for people who are dependent on prescription opioids.
‘This is a growing proportion of our population. In some settings, more than 50% of our client group is prescription opioid dependent,’ she said.
What else needs to change?
An engagement and expansion of Take Home Naloxone (THN) programs – not just in Victoria, but nationally.
Within Victoria, an investment in expanding access to THN is already occurring.
‘We're looking at a trial of vending machines to be able to dispense THN,’ A/Prof Arunogiri said.
Located at health services such as community health centres and hospitals in Melbourne's central business district and inner suburbs, the vending machines are proposed to provide free naloxone and must maintain medicine stability.
‘If pharmacists can be engaged in that process, and promote and advertise awareness of THN – that will be a huge help in preventing these overdoses,’ she said.
Where possible, pharmacies should stock both intranasal and injectable THN formulations.
‘This can help to demystify the process for the lay public, who may be less comfortable administering an injectable product,’ she A/Prof Arunogiri said.
Promoting understanding that naloxone is a safe substance that’s life-saving when administered to someone experiencing an overdose, is also key.
‘We're also really advocating for awareness of THN for people who are prescribed opioids,’ A/Prof Arunogiri said. ‘If you're prescribed an opioid analgesic, you should have access to THN – that's anyone who has hip or back pain, or is prescribed strong opioids for these types of indications.’
Some people have raised concerns about giving naloxone to an unconscious person who may not be experiencing an opioid overdose.
‘But there's no risk; naloxone also won’t interact with anything aside from opioids,’ A/Prof Arunogiri said.
To enhance clinical outcomes and medication safety for people using prescription opioids for chronic pain, access the Opioid Safety Toolkit – co-developed by PSA, Monash University and PainAustralia – which includes an opioid safety plan template, consumer-facing posters and Routine Opioid Outcomes Monitoring templates.
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[post_content] => Yesterday (19 August), it was announced that Ozempic (semaglutide 1.0 mg) has received approval from the Therapeutic Goods Administration (TGA) for an expansion of indication to reduce the risk of kidney disease progression in patients with type 2 diabetes and chronic kidney disease (CKD).
It’s estimated that around 2.7 million Australians are living with indicators of CKD, including both diagnosed and undiagnosed cases.
Of these, diabetes is the leading cause of end stage kidney disease (ESKD) – accounting for over a third (38%) of new cases. Of an estimated 333,000 Australians living with both CKD and diabetes, approximately 10,000 are expected to progress to kidney failure.
If not managed appropriately and in serious cases, CKD may also lead to kidney failure, heart disease and stroke, and in some cases, premature death, said Professor Vlado Perkovic, nephrologist and Provost at the University of New South Wales.
‘Early intervention can help with slowing disease progression,’ he said.
‘This approval represents a step forward in addressing the multifaceted needs of individuals living with type 2 diabetes and CKD,’ added Dr Ana Svensson, Vice President of Clinical, Medical and Regulatory at Novo Nordisk Oceania.
What does the evidence say?
The FLOW (Evaluate Renal Function with Semaglutide Once Weekly) trial is a large multinational study that assessed the effects of once-weekly semaglutide 1.0 mg in adults with type 2 diabetes and CKD.
Participants who received semaglutide had a 24% reduction in risk of major kidney events, slower decline in estimated glomerular filtration rate, and decreased albuminuria – compared to placebo. They also experienced improvements in cardiovascular outcomes and all-cause mortality – with the safety profile consistent with previous studies.
To date, the TGA has not released specific dosing guidance related to the new CKD indication.
Will Ozempic be PBS listed for CKD?
Semaglutide (Ozempic) for CKD is currently not subsidised under the Pharmaceutical Benefits Scheme (PBS).
That means the out-of-pocket costs will not be subsidised, compared to around $31.60 for general patients using the medicine under existing PBS criteria.
‘While it is not specifically reimbursed for kidney disease risk reduction, Novo Nordisk continues to engage with government stakeholders to explore opportunities for broader access to our medicines for Australians living with chronic conditions,’ a spokesperson for Novo Nordisk told Australian Pharmacist.
With Ozempic no longer in shortage, will access open up?
Last month (18 July), the TGA officially removed Ozempic from its medicine shortages list, with previous supply restrictions now lifted. Now that Ozempic stocks have returned to a sufficient level, new patients can be initiated on the medicine. But Ozempic prescribed for weight loss is still off-label, with no update to the indication for weight loss. So the PBS criteria on this front also remain unchanged, and it’s uncertain if this will change any time soon.
‘We have semaglutide 2.4 mg (Wegovy) available – it is indicated for the treatment of patients with obesity or overweight and established cardiovascular disease,’ the Novo Nordisk spokesperson said.
But experts hope that subsidy and accessibility will improve over time as demand and evidence grow.
‘There’s no doubt that both cost and availability present a barrier to the more widespread use of semaglutide at the moment,’ Prof Perkovic said. ‘But I’m sure that over time that situation will change and the drugs will become more widely available.’
[post_title] => Ozempic now indicated to prevent CKD progression
[post_excerpt] => Ozempic is the first medicine in Australia approved to slow kidney disease progression in patients with both type 2 diabetes and CKD.
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[post_content] => This national resource supports frontline assessment, management and prompt referral of burn injuries.
Community pharmacists are often the first point of contact for health concerns and public health initiatives, including burns, said Rebecca Schrale, Burns Nurse Practitioner at the Royal Hobart Hospital’s Burns Unit and Australian and New Zealand Burn Association (ANZBA) Burns Prevention Representative for Tasmania.
‘[So] community pharmacists are in a unique position to provide education on initial first aid, referral and wound care,’ she said. ‘They also have an important role in prevention of burn injuries, educating the community and reducing risk.’
To that end, ANZBA, PSA and the National Australian Pharmacy Students’ Association (NAPSA) collaborated to develop guidelines specifically for pharmacists to assist with the assessment and management of burns.
Australian Pharmacist investigates what pharmacists should look out for and how to manage and refer burns appropriately.
What burns do community pharmacists typically encounter?
The full spectrum – from minor to severe, said PSA Tasmania State Manager Dr Ella van Tienen FPS.
‘A lot of it is advice for minor sunburn or small burns,’ she said. ‘But you do get some more serious burns when people aren’t sure what to do with them, or whether they’re serious enough to [require further attention].’
Burns are more likely to occur out of hours, such as on weekends and public holidays – particularly among children – when general practices are typically closed.
‘That’s when kids are home,’ Dr van Tienen added.
Common causes of burns in children include hot water scalds due to access to kettles or stove tops.
‘Teenagers who are newly independent and off at the beach on their own, also present with blistering sunburn,’ she said.
What impact do burns have on the community?
It’s important to remember that even minor burns can have long-term effects on the patient in regard to range of movement, function and the look and feel of the scar, Ms Schrale said.
‘All burn injuries – whether large or small can have a psychological effect on the individual and their family,’ she said. ‘And it’s imperative that patients are referred to burns clinicians in a timely manner.’
Deep burn injuries will result in scarring and could restrict the function of the area that is affected.
‘Pharmacies are often open after hours and on weekends so again they provide clients and their families with timely advice, education and support,’ Ms Schrale said.
What does the burns resource involve?
The new Pharmacists Advisory Card and A3 Poster are new iterations of an old resource, Dr van Tienen said.
‘The original resource had been around for many years, and it needed to be updated,’ she said.
The refreshed burns advisory resource provides pharmacists with up-to-date information on Burns First Aid, and assessment – including burn depth, assessment and minor burn wound care, Ms Schrale said.
‘With this knowledge they are equipped to then follow the ANZBA referral guidelines, highlighting who requires discussion or referral to primary [care] or the local emergency department (ED),’ she said. ‘The updated card ensures the messaging is consistent across pharmacies, community health, primary care and EDs nationally.’
What new information is included?
The new version of the card focuses on information that will assist in early assessment, management and referral of minor burns, Ms Schrale said.
‘It also provides simple and consistent messaging on wound care and medical emergencies – such as large surface area burns, airway burns, circumferential burns and infection,’ she said.
‘The other new addition is the inclusion of information on burns scar management based on evidence-based practice and encouraging referral for any patient who sustains a scar from a burn injury.’
How can the burns resource be used in practice?
Let’s say a parent presents to the pharmacy with a child who has sustained a burn after accidentally knocking over a pot of boiling water while cooking pasta on the stove.
‘If the child has a small [dermal] burn that’s not significantly blistered, the pharmacist could appropriately treat it in the community by providing first aid and dressing advice,’ Dr van Tienen said.
‘The pharmacist should advise the parent to watch out for [significant] blistering, the blisters breaking, any signs of infection or excessive [levels] of pain.’
Indicators that should prompt further action include if the child:
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[post_content] => Too many people are taking way too much Vitamin B6. Here are the risks of high doses and how the Therapeutic Goods Administration (TGA) is responding.
What is the concern about Vitamin B6?
High doses and/or prolonged use of Vitamin B6 above the recommended daily intake (RDI) have been linked to peripheral neuropathy. Most cases have been reported at doses exceeding 500 mg/day, although cases at lower doses have been reported.1
The TGA’s adverse events notification database contains 174 reports1 of peripheral neuropathy, peripheral sensory neuropathy, small fibre neuropathy or chronic polyneuropathy for products containing Vitamin B6.1
The primary concern is the risk of overconsumption of Vitamin B6 from a variety of sources, particularly in individuals using multiple multivitamin and supplement products.1
How many products have Vitamin B6 in them?
Lots! There are over 1,500 products listed on the Australian Register of Therapeutic Goods (ARTG) which contain Vitamin B6. Approximately 100 of these products have more than 50 mg of Vitamin B6 as the single active ingredient.
The inclusion of Vitamin B6 in these products is rarely prominently displayed. And labelling of Vitamin B6 is often not visible to or understood by consumers, instead being referenced as pyridoxine, pyridoxine hydrochloride, pyridoxal 5-phosphate and pyridoxal 5-phosphate monohydrate.1
What is the TGA doing?
The TGA Delegate has made an interim decision to amend the scheduling of medicines containing more than 50 mg of Vitamin B6 but less than 200 mg (per recommended daily dose) to classify them as Pharmacist Only Medicines (Schedule 3).
If the TGA Delegate’s interim decision is confirmed, the schedule changes will take effect on 1 February 2027.
What should pharmacists do differently?
Ensure all consumers are asked if they are taking multiple vitamin or mineral supplements every time a Vitamin B6-containing product is requested or supplied. Where this is the case, it’s important to consider total Vitamin B6 dose, including dietary sources, and ensure it does not exceed 200 mg daily.
Pharmacists should also warn of early signs of neuropathy, such as tingling, burning or numbness – and advise they cease the medicine and seek medical review if this occurs.
Should pharmacists still supply Vitamin B6 for use in pregnancy?
There are a couple of different treatment regimens for pyridoxine (Vitamin B6) tablets for nausea and vomiting of pregnancy which involve divided doses.2–4 Some references caution against quality of evidence and modest benefit.
The maximum daily dose should not exceed 200 mg. This upper dose is generally considered to be safe for the duration of pregnancy.
References
- Australian Government Department of Health, Disability and Ageing. Therapeutic Goods Administration. Notice of interim decision to amend (or not amend) the current Poisons Standard in relation to pyridoxine, pyridoxal or pyridoxamine (vitamin B6). 2025. At: www.tga.gov.au/sites/default/files/2025-06/notice-interim-decision-amend-or-not-amend-current-poisons-standard-pyridoxine-pyridoxal-pyridoxamine-vitaminb6.pdf
- Therapeutic Guidelines: Nausea and vomiting during pregnancy. 2025. At: www.tg.org.au
- Government of Western Australia. North Metropolitan Health Service Women and Newborn Health Service. Pyridoxine (Vitamin B6). 2024. At: www.kemh.health.wa.gov.au/~/media/HSPs/NMHS/Hospitals/WNHS/Documents/Clinical-guidelines/Obs-Gyn-MPs/Pyridoxine---Vitamin-B6.pdf?thn=0
- Safer Care Victoria. Medications to treat hyperemesis. 2025. At: www.safercare.vic.gov.au/best-practice-improvement/clinical-guidance/maternity/nausea-and-vomiting#goto-table1.-medications-to-treat-hyperemesis
[post_title] => How pharmacists should address rising B6 overuse
[post_excerpt] => Too many people are taking way too much Vitamin B6. A senior pharmacist explains the risks of high doses, and how the TGA is responding.
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[post_content] => Patients often find creative ways to remember to take their medicines. These might include alarms and reminder apps or placing medicines in visible locations like kitchen benches or
bedside tables. However, some patients remove medicines from their original packaging to make their medication routine more convenient.
They might transfer them into pill organisers, plastic bags or leave them loose in pockets or
handbags. While these strategies may help with adherence, they can also compromise
medicine stability and effectiveness.1
Challenges of repackaging medicines
While manufacturers test the stability of medicines in original packaging, this assurance of stability over the shelf life is lost once medicines are removed from the original packaging.2,3
A national study of community pharmacists found that 88% had observed visible changes
in repackaged medicines, including discolouration, softening and enteric coat rupture. These changes were most frequently reported in humid and hot climates.1
In these high-risk climates, sodium valproate, telmisartan, and aspirin were found to be particularly susceptible to physical instability.1
Patient storage practices: a critical factor
Despite pharmacist recommendations, patients may unknowingly compromise their medicines’ safety by exposing them to heat, moisture or light, leading to degradation and reduced effectiveness. Common storage locations (e.g. bathroom cabinet, car) can contribute to degradation.
For instance, enteric-coated tablets, designed to resist stomach acid, were found to rupture prematurely when exposed to moisture. Softening of tablets and capsules was also frequently noted, leading to crumbling or loss of integrity. These changes can compromise drug efficacy and patient safety, particularly for medicines with a narrow therapeutic index.4
Best practices for medicine storage at home
To maintain medicine stability and effectiveness, patients should follow key storage principles:
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[post_content] => A recent report conducted by the Coroners Court of Victoria found that overdose deaths in 2024 were the highest they have been in a decade.
And of the 584 Victorians who died of an overdose last year, a stark proportion were related to illegal drugs, said Associate Professor Shalini Arunogiri, NHMRC Emerging Leader Research Fellow at Monash Addiction Research Centre and Eastern Health Clinical School.
‘A decade ago, they accounted for less than 50% of overdose deaths. But in 2024, that contribution is now 65% – with a year-on-year increase in the last few years.’
A significant contributor to this trend is the increase in heroin-related deaths, with 248 deaths in the last year compared to 204 in 2023.
‘There has also been a significant increase in the number of methamphetamine-related deaths – which have tripled over the last decade [to 215 deaths],’ A/Prof Arunogiri said.
A sub-analysis of the report, looking at accidental versus intentional overdose, found the vast majority (75%) of deaths were accidental. Men aged 35–54 were also most at risk, as are those who live in urban areas – with three-quarters of deaths occurring in metropolitan Melbourne.
‘[But] in the cases where it was thought to be intentional, women are over-represented in that group,’ she said.
What’s driving these trends?
A good indicator is understanding who’s accessing treatment, A/Prof Arunogiri said.
‘We have treatment-specific data that we can compare and contrast with, and then we also have national survey data,’ she said.
‘From both those sources, what we see is a high proportion of the opioid-related [treatment] cases are prescription opioids’.
In other words, those accessing opioid replacement therapy (ORT) are more likely to be patients who use prescription, rather than illegal, opioids – leaving the latter more susceptible to overdose.
‘We've seen extended waits for people to access prescribing and treatment in the Victorian setting,’ she said. ‘It’s a concerning trend to see a rise in heroin-related deaths because people are not able to get into treatment quickly for opioids at the moment.’
Another potential contributor to overdose deaths linked to illegal drugs is contaminants in the supply – including novel synthetic opioids such as nitazenes. However, we won’t know the impact of this straight away, A/Prof Arunogiri said.
‘This is a very quickly emerging trend,’ she said. ‘With the most recent data on [this] report being the full year of 2024, it might not reflect exactly what we're seeing on the ground just yet. But we'd be expecting that in the next year of data there will be a potential escalation in those deaths.’
What role is prescribing playing?
Since 2020, there has been a downturn in the number of overdose deaths related to pharmaceutical opioids.
This could be because opioid prescribing in Australia decreased by 21% between 2015 and 2022, driven by a series of regulatory and policy changes. This includes the tightening of prescribing rules in June 2020, which set limits on repeat scripts, mandated smaller pack sizes for immediate-release opioids and increased requirements for prescriber authorisation.
However, Australia still ranks among the top countries in per-capita opioid prescribing, with opioids remaining the primary cause of drug-induced deaths. And Victoria’s real-time prescription monitoring system, SafeScript, doesn't appear to be reducing high-risk opioid prescribing.
A 2023 study found that there was no significant impact on the prescribing of high-dose opioids or high‑risk combinations such as opioids with benzodiazepines or pregabalin. Instead, reductions occurred in low‑dose opioid prescribing. And at the same time, there was evidence of unintended substitution effects, with increased initiation of medicines such as tricyclic antidepressants, pregabalin and tramadol.
While not a major contributor to annual overdose deaths, the number of pregabalin-related deaths have risen – reaching 92 in 2024, versus 34 in 2015.
With gabapentinoids (pregabalin and gabapentin) and tramadol added to SafeScript 2 years ago, A/Prof Arunogiri said it will be interesting to see what occurs in this space.
‘We particularly want to keep an eye on pregabalin-related deaths,’ she said.
What are the bottlenecks to ORT access?
Reforms to Pharmaceutical Benefits Scheme (PBS) Opioid Dependence Treatment (ODT) medicine arrangements have widened access to treatment by improving affordability.
But in Victoria, the vast majority of ORT prescribing occurs within general practice settings rather than public sector settings, A/Prof Arunogiri said.
‘So the block, rather than being a dispensing issue, is on the prescribing end – with the waits to get into treatment increasing over time,’ she said.
‘When prescribers retire, there’s a huge bottleneck preventing people from getting into treatment, because it's such a small prescribing pool in the state.’
Within Victoria, there's been significant advocacy for systemic reform of the opioid pharmacotherapy system to reduce wait times and increase public sector involvement.
Shared-care involvement in ORT programs should help to improve access and engagement with therapy.
‘There are novel pharmacy shared care models that are starting to be trialled,’ A/Prof Arunogiri said.
‘This supports pharmacists' involvement, not just at the dispensing end, but also in prescribing – including working with local GPs in a model that enables expanded access to medication.’
Across the country, the message appears to be getting through about ODT for people who are dependent on prescription opioids.
‘This is a growing proportion of our population. In some settings, more than 50% of our client group is prescription opioid dependent,’ she said.
What else needs to change?
An engagement and expansion of Take Home Naloxone (THN) programs – not just in Victoria, but nationally.
Within Victoria, an investment in expanding access to THN is already occurring.
‘We're looking at a trial of vending machines to be able to dispense THN,’ A/Prof Arunogiri said.
Located at health services such as community health centres and hospitals in Melbourne's central business district and inner suburbs, the vending machines are proposed to provide free naloxone and must maintain medicine stability.
‘If pharmacists can be engaged in that process, and promote and advertise awareness of THN – that will be a huge help in preventing these overdoses,’ she said.
Where possible, pharmacies should stock both intranasal and injectable THN formulations.
‘This can help to demystify the process for the lay public, who may be less comfortable administering an injectable product,’ she A/Prof Arunogiri said.
Promoting understanding that naloxone is a safe substance that’s life-saving when administered to someone experiencing an overdose, is also key.
‘We're also really advocating for awareness of THN for people who are prescribed opioids,’ A/Prof Arunogiri said. ‘If you're prescribed an opioid analgesic, you should have access to THN – that's anyone who has hip or back pain, or is prescribed strong opioids for these types of indications.’
Some people have raised concerns about giving naloxone to an unconscious person who may not be experiencing an opioid overdose.
‘But there's no risk; naloxone also won’t interact with anything aside from opioids,’ A/Prof Arunogiri said.
To enhance clinical outcomes and medication safety for people using prescription opioids for chronic pain, access the Opioid Safety Toolkit – co-developed by PSA, Monash University and PainAustralia – which includes an opioid safety plan template, consumer-facing posters and Routine Opioid Outcomes Monitoring templates.
[post_title] => Overdose deaths hit decade-high in Victoria
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[post_content] => Yesterday (19 August), it was announced that Ozempic (semaglutide 1.0 mg) has received approval from the Therapeutic Goods Administration (TGA) for an expansion of indication to reduce the risk of kidney disease progression in patients with type 2 diabetes and chronic kidney disease (CKD).
It’s estimated that around 2.7 million Australians are living with indicators of CKD, including both diagnosed and undiagnosed cases.
Of these, diabetes is the leading cause of end stage kidney disease (ESKD) – accounting for over a third (38%) of new cases. Of an estimated 333,000 Australians living with both CKD and diabetes, approximately 10,000 are expected to progress to kidney failure.
If not managed appropriately and in serious cases, CKD may also lead to kidney failure, heart disease and stroke, and in some cases, premature death, said Professor Vlado Perkovic, nephrologist and Provost at the University of New South Wales.
‘Early intervention can help with slowing disease progression,’ he said.
‘This approval represents a step forward in addressing the multifaceted needs of individuals living with type 2 diabetes and CKD,’ added Dr Ana Svensson, Vice President of Clinical, Medical and Regulatory at Novo Nordisk Oceania.
What does the evidence say?
The FLOW (Evaluate Renal Function with Semaglutide Once Weekly) trial is a large multinational study that assessed the effects of once-weekly semaglutide 1.0 mg in adults with type 2 diabetes and CKD.
Participants who received semaglutide had a 24% reduction in risk of major kidney events, slower decline in estimated glomerular filtration rate, and decreased albuminuria – compared to placebo. They also experienced improvements in cardiovascular outcomes and all-cause mortality – with the safety profile consistent with previous studies.
To date, the TGA has not released specific dosing guidance related to the new CKD indication.
Will Ozempic be PBS listed for CKD?
Semaglutide (Ozempic) for CKD is currently not subsidised under the Pharmaceutical Benefits Scheme (PBS).
That means the out-of-pocket costs will not be subsidised, compared to around $31.60 for general patients using the medicine under existing PBS criteria.
‘While it is not specifically reimbursed for kidney disease risk reduction, Novo Nordisk continues to engage with government stakeholders to explore opportunities for broader access to our medicines for Australians living with chronic conditions,’ a spokesperson for Novo Nordisk told Australian Pharmacist.
With Ozempic no longer in shortage, will access open up?
Last month (18 July), the TGA officially removed Ozempic from its medicine shortages list, with previous supply restrictions now lifted. Now that Ozempic stocks have returned to a sufficient level, new patients can be initiated on the medicine. But Ozempic prescribed for weight loss is still off-label, with no update to the indication for weight loss. So the PBS criteria on this front also remain unchanged, and it’s uncertain if this will change any time soon.
‘We have semaglutide 2.4 mg (Wegovy) available – it is indicated for the treatment of patients with obesity or overweight and established cardiovascular disease,’ the Novo Nordisk spokesperson said.
But experts hope that subsidy and accessibility will improve over time as demand and evidence grow.
‘There’s no doubt that both cost and availability present a barrier to the more widespread use of semaglutide at the moment,’ Prof Perkovic said. ‘But I’m sure that over time that situation will change and the drugs will become more widely available.’
[post_title] => Ozempic now indicated to prevent CKD progression
[post_excerpt] => Ozempic is the first medicine in Australia approved to slow kidney disease progression in patients with both type 2 diabetes and CKD.
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[post_content] => This national resource supports frontline assessment, management and prompt referral of burn injuries.
Community pharmacists are often the first point of contact for health concerns and public health initiatives, including burns, said Rebecca Schrale, Burns Nurse Practitioner at the Royal Hobart Hospital’s Burns Unit and Australian and New Zealand Burn Association (ANZBA) Burns Prevention Representative for Tasmania.
‘[So] community pharmacists are in a unique position to provide education on initial first aid, referral and wound care,’ she said. ‘They also have an important role in prevention of burn injuries, educating the community and reducing risk.’
To that end, ANZBA, PSA and the National Australian Pharmacy Students’ Association (NAPSA) collaborated to develop guidelines specifically for pharmacists to assist with the assessment and management of burns.
Australian Pharmacist investigates what pharmacists should look out for and how to manage and refer burns appropriately.
What burns do community pharmacists typically encounter?
The full spectrum – from minor to severe, said PSA Tasmania State Manager Dr Ella van Tienen FPS.
‘A lot of it is advice for minor sunburn or small burns,’ she said. ‘But you do get some more serious burns when people aren’t sure what to do with them, or whether they’re serious enough to [require further attention].’
Burns are more likely to occur out of hours, such as on weekends and public holidays – particularly among children – when general practices are typically closed.
‘That’s when kids are home,’ Dr van Tienen added.
Common causes of burns in children include hot water scalds due to access to kettles or stove tops.
‘Teenagers who are newly independent and off at the beach on their own, also present with blistering sunburn,’ she said.
What impact do burns have on the community?
It’s important to remember that even minor burns can have long-term effects on the patient in regard to range of movement, function and the look and feel of the scar, Ms Schrale said.
‘All burn injuries – whether large or small can have a psychological effect on the individual and their family,’ she said. ‘And it’s imperative that patients are referred to burns clinicians in a timely manner.’
Deep burn injuries will result in scarring and could restrict the function of the area that is affected.
‘Pharmacies are often open after hours and on weekends so again they provide clients and their families with timely advice, education and support,’ Ms Schrale said.
What does the burns resource involve?
The new Pharmacists Advisory Card and A3 Poster are new iterations of an old resource, Dr van Tienen said.
‘The original resource had been around for many years, and it needed to be updated,’ she said.
The refreshed burns advisory resource provides pharmacists with up-to-date information on Burns First Aid, and assessment – including burn depth, assessment and minor burn wound care, Ms Schrale said.
‘With this knowledge they are equipped to then follow the ANZBA referral guidelines, highlighting who requires discussion or referral to primary [care] or the local emergency department (ED),’ she said. ‘The updated card ensures the messaging is consistent across pharmacies, community health, primary care and EDs nationally.’
What new information is included?
The new version of the card focuses on information that will assist in early assessment, management and referral of minor burns, Ms Schrale said.
‘It also provides simple and consistent messaging on wound care and medical emergencies – such as large surface area burns, airway burns, circumferential burns and infection,’ she said.
‘The other new addition is the inclusion of information on burns scar management based on evidence-based practice and encouraging referral for any patient who sustains a scar from a burn injury.’
How can the burns resource be used in practice?
Let’s say a parent presents to the pharmacy with a child who has sustained a burn after accidentally knocking over a pot of boiling water while cooking pasta on the stove.
‘If the child has a small [dermal] burn that’s not significantly blistered, the pharmacist could appropriately treat it in the community by providing first aid and dressing advice,’ Dr van Tienen said.
‘The pharmacist should advise the parent to watch out for [significant] blistering, the blisters breaking, any signs of infection or excessive [levels] of pain.’
Indicators that should prompt further action include if the child:
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[post_content] => Too many people are taking way too much Vitamin B6. Here are the risks of high doses and how the Therapeutic Goods Administration (TGA) is responding.
What is the concern about Vitamin B6?
High doses and/or prolonged use of Vitamin B6 above the recommended daily intake (RDI) have been linked to peripheral neuropathy. Most cases have been reported at doses exceeding 500 mg/day, although cases at lower doses have been reported.1
The TGA’s adverse events notification database contains 174 reports1 of peripheral neuropathy, peripheral sensory neuropathy, small fibre neuropathy or chronic polyneuropathy for products containing Vitamin B6.1
The primary concern is the risk of overconsumption of Vitamin B6 from a variety of sources, particularly in individuals using multiple multivitamin and supplement products.1
How many products have Vitamin B6 in them?
Lots! There are over 1,500 products listed on the Australian Register of Therapeutic Goods (ARTG) which contain Vitamin B6. Approximately 100 of these products have more than 50 mg of Vitamin B6 as the single active ingredient.
The inclusion of Vitamin B6 in these products is rarely prominently displayed. And labelling of Vitamin B6 is often not visible to or understood by consumers, instead being referenced as pyridoxine, pyridoxine hydrochloride, pyridoxal 5-phosphate and pyridoxal 5-phosphate monohydrate.1
What is the TGA doing?
The TGA Delegate has made an interim decision to amend the scheduling of medicines containing more than 50 mg of Vitamin B6 but less than 200 mg (per recommended daily dose) to classify them as Pharmacist Only Medicines (Schedule 3).
If the TGA Delegate’s interim decision is confirmed, the schedule changes will take effect on 1 February 2027.
What should pharmacists do differently?
Ensure all consumers are asked if they are taking multiple vitamin or mineral supplements every time a Vitamin B6-containing product is requested or supplied. Where this is the case, it’s important to consider total Vitamin B6 dose, including dietary sources, and ensure it does not exceed 200 mg daily.
Pharmacists should also warn of early signs of neuropathy, such as tingling, burning or numbness – and advise they cease the medicine and seek medical review if this occurs.
Should pharmacists still supply Vitamin B6 for use in pregnancy?
There are a couple of different treatment regimens for pyridoxine (Vitamin B6) tablets for nausea and vomiting of pregnancy which involve divided doses.2–4 Some references caution against quality of evidence and modest benefit.
The maximum daily dose should not exceed 200 mg. This upper dose is generally considered to be safe for the duration of pregnancy.
References
- Australian Government Department of Health, Disability and Ageing. Therapeutic Goods Administration. Notice of interim decision to amend (or not amend) the current Poisons Standard in relation to pyridoxine, pyridoxal or pyridoxamine (vitamin B6). 2025. At: www.tga.gov.au/sites/default/files/2025-06/notice-interim-decision-amend-or-not-amend-current-poisons-standard-pyridoxine-pyridoxal-pyridoxamine-vitaminb6.pdf
- Therapeutic Guidelines: Nausea and vomiting during pregnancy. 2025. At: www.tg.org.au
- Government of Western Australia. North Metropolitan Health Service Women and Newborn Health Service. Pyridoxine (Vitamin B6). 2024. At: www.kemh.health.wa.gov.au/~/media/HSPs/NMHS/Hospitals/WNHS/Documents/Clinical-guidelines/Obs-Gyn-MPs/Pyridoxine---Vitamin-B6.pdf?thn=0
- Safer Care Victoria. Medications to treat hyperemesis. 2025. At: www.safercare.vic.gov.au/best-practice-improvement/clinical-guidance/maternity/nausea-and-vomiting#goto-table1.-medications-to-treat-hyperemesis
[post_title] => How pharmacists should address rising B6 overuse
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Australian Pharmacist is the official journal for Pharmaceutical Society of Australia Ltd.
