Dr Judith Singleton
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[post_content] => New research has found that ibuprofen and paracetamol may be contributing to antimicrobial resistance – particularly when used in combination.
Researchers from the University of South Australia conducted a study in residential aged care facilities (RACFs) on antimicrobial resistance, looking at the interactions between organisms such as Escherichia coli, non-antibiotic medicines and the broad-spectrum antibiotic ciprofloxacin, Lead Researcher Associate Professor Rietie Venter told Australian Pharmacist.
‘We also looked at an antibiotic-sensitive microorganism we isolated from a resident and we treated this microorganism with nine medications which are frequently used in the older population,’ she said.
The microorganisms were treated with the medicines – including ibuprofen, diclofenac, paracetamol, furosemide, metformin, atorvastatin, tramadol, temazepam and pseudoephedrine – both individually and in combinations of two.
Paracetamol and ibuprofen were found to increase ciprofloxacin resistance in this gut bacterium separately, and even more so when combined.
‘When bacteria were exposed to ciprofloxacin alongside ibuprofen and paracetamol, they developed more genetic mutations than with the antibiotic alone, helping them grow faster and become highly resistant,’ A/Prof Venter said.
‘Worryingly, the bacteria were not only resistant to the antibiotic ciprofloxacin, but increased resistance was also observed to multiple other antibiotics from different classes.’
How do paracetamol and ibuprofen increase antimicrobial resistance?
Sequencing in follow-up studies revealed how the organism acquired mutations, A/Prof Venter said.
‘Evolution is turbocharged in these little microbes; under ideal conditions, organisms like the one we used double every 20 minutes,’ she said.
‘If they get stressed by the addition of paracetamol and an antibiotic, they mutate. While some of those mutations make them more vulnerable, many might actually make them resistant.’
Mutations conferring resistance to ciprofloxacin were identified, along with efflux pumps – membrane proteins that expel antibiotics before they can reach their targets.
‘When used in combination, a synergy between the two medicines causes increased mutations, leading to higher levels of resistance.’
On a positive note, none of the other nine medicines analysed in the research increased antimicrobial resistance in the gut bacteria.
‘None of the other medications, when combined with ibuprofen, were worse than ibuprofen by itself,’ she said.
Are there certain populations who could be more at risk?
Older Australians, particularly those in RACFs, are a reservoir for antimicrobial resistance.
‘Older people are more likely to be prescribed multiple medications – not just antibiotics, but also medicines for pain, sleep, or blood pressure – making them an ideal breeding ground for gut bacteria to become resistant to antibiotics,’ A/Prof Venter.
While more research is needed before any policy change may be considered, A/Prof Venter thinks it’s important to understand why these analgesics are being taken together and to consider alternative options.
‘We would love to do more research to see if there is a way we can exchange an [analgesic] for another pain medication that doesn't cause the enhanced antimicrobial resistance, or if there's a certain time between taking them that’s better.’
What advice should pharmacists provide to patients?
It’s common for antibiotics to be combined with over-the-counter analgesics. For example, a woman with a urinary tract infection who is taking an antibiotic might also take an analgesic for pain relief, or a child with a bacterial infection such as tonsillitis who is prescribed azithromycin could be administered ibuprofen and paracetamol to manage a high fever.
The research provides an opportunity for pharmacists to raise awareness among patients about the risks of antimicrobial resistance, A/Prof Venter said.
‘It’s well known that the use of antibiotics may cause antimicrobial resistance,’ she said. ‘But it’s not considered that these frequently used medications can also increase antimicrobial resistance.’
The paracetamol scheduling changes introduced earlier this year are also an important step in building public awareness that these medicines are not as harmless as they might appear, A/Prof Venter believes.
‘Compared to many other medications, people tend to think of [paracetamol and ibuprofen] as completely harmless,’ she said. ‘So strategies such as smaller pack sizes can lead to changes in behaviour.’
PSA’s Medicine safety: Child and adolescent care report found that pharmacists have an increasing role in helping patients use common analgesics safely, with approximately 16% of pharmaceutical poisoning hospital admissions in children under 5 years of age being attributed to paracetamol.
‘By limiting the maximum pack sizes of paracetamol, we are opening the door to have a conversation about the risks and benefits of these medicines – both in the pharmacy and at home – and take steps as a community to promote the safe use of medicines,’ said PSA National President Associate Professor Fei Sim FPS.
‘By involving pharmacists in the supply of paracetamol in larger pack sizes, we strike the right balance between access and safety, giving pharmacists the opportunity to help patients manage their pain effectively while reducing the risk of misuse and harm.’
[post_title] => Common analgesics may be contributing to antimicrobial resistance
[post_excerpt] => New research has found that ibuprofen and paracetamol may contribute to antimicrobial resistance – particularly when used in combination.
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[post_content] => On Monday (25 August) PSA introduced the new crop of leaders for the Early Career Pharmacist (ECP) Community of Specialty Interest (CSI) – a dynamic group dedicated to empowering the next generation of pharmacists across Australia.
Dr Ayomide Ogundipe MPS has been re-appointed for a third term as Chair of the Early Career Pharmacist Leadership Group and ECP Director on the PSA National Board.
For the first time the ECP CSI will also include a representative practising in the Northern Territory.
The 2025-26 Early Career Pharmacists CSI is led by:
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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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[title_attribute] => Ozempic now indicated to prevent CKD progression
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[post_content] => New research has found that ibuprofen and paracetamol may be contributing to antimicrobial resistance – particularly when used in combination.
Researchers from the University of South Australia conducted a study in residential aged care facilities (RACFs) on antimicrobial resistance, looking at the interactions between organisms such as Escherichia coli, non-antibiotic medicines and the broad-spectrum antibiotic ciprofloxacin, Lead Researcher Associate Professor Rietie Venter told Australian Pharmacist.
‘We also looked at an antibiotic-sensitive microorganism we isolated from a resident and we treated this microorganism with nine medications which are frequently used in the older population,’ she said.
The microorganisms were treated with the medicines – including ibuprofen, diclofenac, paracetamol, furosemide, metformin, atorvastatin, tramadol, temazepam and pseudoephedrine – both individually and in combinations of two.
Paracetamol and ibuprofen were found to increase ciprofloxacin resistance in this gut bacterium separately, and even more so when combined.
‘When bacteria were exposed to ciprofloxacin alongside ibuprofen and paracetamol, they developed more genetic mutations than with the antibiotic alone, helping them grow faster and become highly resistant,’ A/Prof Venter said.
‘Worryingly, the bacteria were not only resistant to the antibiotic ciprofloxacin, but increased resistance was also observed to multiple other antibiotics from different classes.’
How do paracetamol and ibuprofen increase antimicrobial resistance?
Sequencing in follow-up studies revealed how the organism acquired mutations, A/Prof Venter said.
‘Evolution is turbocharged in these little microbes; under ideal conditions, organisms like the one we used double every 20 minutes,’ she said.
‘If they get stressed by the addition of paracetamol and an antibiotic, they mutate. While some of those mutations make them more vulnerable, many might actually make them resistant.’
Mutations conferring resistance to ciprofloxacin were identified, along with efflux pumps – membrane proteins that expel antibiotics before they can reach their targets.
‘When used in combination, a synergy between the two medicines causes increased mutations, leading to higher levels of resistance.’
On a positive note, none of the other nine medicines analysed in the research increased antimicrobial resistance in the gut bacteria.
‘None of the other medications, when combined with ibuprofen, were worse than ibuprofen by itself,’ she said.
Are there certain populations who could be more at risk?
Older Australians, particularly those in RACFs, are a reservoir for antimicrobial resistance.
‘Older people are more likely to be prescribed multiple medications – not just antibiotics, but also medicines for pain, sleep, or blood pressure – making them an ideal breeding ground for gut bacteria to become resistant to antibiotics,’ A/Prof Venter.
While more research is needed before any policy change may be considered, A/Prof Venter thinks it’s important to understand why these analgesics are being taken together and to consider alternative options.
‘We would love to do more research to see if there is a way we can exchange an [analgesic] for another pain medication that doesn't cause the enhanced antimicrobial resistance, or if there's a certain time between taking them that’s better.’
What advice should pharmacists provide to patients?
It’s common for antibiotics to be combined with over-the-counter analgesics. For example, a woman with a urinary tract infection who is taking an antibiotic might also take an analgesic for pain relief, or a child with a bacterial infection such as tonsillitis who is prescribed azithromycin could be administered ibuprofen and paracetamol to manage a high fever.
The research provides an opportunity for pharmacists to raise awareness among patients about the risks of antimicrobial resistance, A/Prof Venter said.
‘It’s well known that the use of antibiotics may cause antimicrobial resistance,’ she said. ‘But it’s not considered that these frequently used medications can also increase antimicrobial resistance.’
The paracetamol scheduling changes introduced earlier this year are also an important step in building public awareness that these medicines are not as harmless as they might appear, A/Prof Venter believes.
‘Compared to many other medications, people tend to think of [paracetamol and ibuprofen] as completely harmless,’ she said. ‘So strategies such as smaller pack sizes can lead to changes in behaviour.’
PSA’s Medicine safety: Child and adolescent care report found that pharmacists have an increasing role in helping patients use common analgesics safely, with approximately 16% of pharmaceutical poisoning hospital admissions in children under 5 years of age being attributed to paracetamol.
‘By limiting the maximum pack sizes of paracetamol, we are opening the door to have a conversation about the risks and benefits of these medicines – both in the pharmacy and at home – and take steps as a community to promote the safe use of medicines,’ said PSA National President Associate Professor Fei Sim FPS.
‘By involving pharmacists in the supply of paracetamol in larger pack sizes, we strike the right balance between access and safety, giving pharmacists the opportunity to help patients manage their pain effectively while reducing the risk of misuse and harm.’
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[post_content] => On Monday (25 August) PSA introduced the new crop of leaders for the Early Career Pharmacist (ECP) Community of Specialty Interest (CSI) – a dynamic group dedicated to empowering the next generation of pharmacists across Australia.
Dr Ayomide Ogundipe MPS has been re-appointed for a third term as Chair of the Early Career Pharmacist Leadership Group and ECP Director on the PSA National Board.
For the first time the ECP CSI will also include a representative practising in the Northern Territory.
The 2025-26 Early Career Pharmacists CSI is led by:
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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] => New research has found that ibuprofen and paracetamol may be contributing to antimicrobial resistance – particularly when used in combination.
Researchers from the University of South Australia conducted a study in residential aged care facilities (RACFs) on antimicrobial resistance, looking at the interactions between organisms such as Escherichia coli, non-antibiotic medicines and the broad-spectrum antibiotic ciprofloxacin, Lead Researcher Associate Professor Rietie Venter told Australian Pharmacist.
‘We also looked at an antibiotic-sensitive microorganism we isolated from a resident and we treated this microorganism with nine medications which are frequently used in the older population,’ she said.
The microorganisms were treated with the medicines – including ibuprofen, diclofenac, paracetamol, furosemide, metformin, atorvastatin, tramadol, temazepam and pseudoephedrine – both individually and in combinations of two.
Paracetamol and ibuprofen were found to increase ciprofloxacin resistance in this gut bacterium separately, and even more so when combined.
‘When bacteria were exposed to ciprofloxacin alongside ibuprofen and paracetamol, they developed more genetic mutations than with the antibiotic alone, helping them grow faster and become highly resistant,’ A/Prof Venter said.
‘Worryingly, the bacteria were not only resistant to the antibiotic ciprofloxacin, but increased resistance was also observed to multiple other antibiotics from different classes.’
How do paracetamol and ibuprofen increase antimicrobial resistance?
Sequencing in follow-up studies revealed how the organism acquired mutations, A/Prof Venter said.
‘Evolution is turbocharged in these little microbes; under ideal conditions, organisms like the one we used double every 20 minutes,’ she said.
‘If they get stressed by the addition of paracetamol and an antibiotic, they mutate. While some of those mutations make them more vulnerable, many might actually make them resistant.’
Mutations conferring resistance to ciprofloxacin were identified, along with efflux pumps – membrane proteins that expel antibiotics before they can reach their targets.
‘When used in combination, a synergy between the two medicines causes increased mutations, leading to higher levels of resistance.’
On a positive note, none of the other nine medicines analysed in the research increased antimicrobial resistance in the gut bacteria.
‘None of the other medications, when combined with ibuprofen, were worse than ibuprofen by itself,’ she said.
Are there certain populations who could be more at risk?
Older Australians, particularly those in RACFs, are a reservoir for antimicrobial resistance.
‘Older people are more likely to be prescribed multiple medications – not just antibiotics, but also medicines for pain, sleep, or blood pressure – making them an ideal breeding ground for gut bacteria to become resistant to antibiotics,’ A/Prof Venter.
While more research is needed before any policy change may be considered, A/Prof Venter thinks it’s important to understand why these analgesics are being taken together and to consider alternative options.
‘We would love to do more research to see if there is a way we can exchange an [analgesic] for another pain medication that doesn't cause the enhanced antimicrobial resistance, or if there's a certain time between taking them that’s better.’
What advice should pharmacists provide to patients?
It’s common for antibiotics to be combined with over-the-counter analgesics. For example, a woman with a urinary tract infection who is taking an antibiotic might also take an analgesic for pain relief, or a child with a bacterial infection such as tonsillitis who is prescribed azithromycin could be administered ibuprofen and paracetamol to manage a high fever.
The research provides an opportunity for pharmacists to raise awareness among patients about the risks of antimicrobial resistance, A/Prof Venter said.
‘It’s well known that the use of antibiotics may cause antimicrobial resistance,’ she said. ‘But it’s not considered that these frequently used medications can also increase antimicrobial resistance.’
The paracetamol scheduling changes introduced earlier this year are also an important step in building public awareness that these medicines are not as harmless as they might appear, A/Prof Venter believes.
‘Compared to many other medications, people tend to think of [paracetamol and ibuprofen] as completely harmless,’ she said. ‘So strategies such as smaller pack sizes can lead to changes in behaviour.’
PSA’s Medicine safety: Child and adolescent care report found that pharmacists have an increasing role in helping patients use common analgesics safely, with approximately 16% of pharmaceutical poisoning hospital admissions in children under 5 years of age being attributed to paracetamol.
‘By limiting the maximum pack sizes of paracetamol, we are opening the door to have a conversation about the risks and benefits of these medicines – both in the pharmacy and at home – and take steps as a community to promote the safe use of medicines,’ said PSA National President Associate Professor Fei Sim FPS.
‘By involving pharmacists in the supply of paracetamol in larger pack sizes, we strike the right balance between access and safety, giving pharmacists the opportunity to help patients manage their pain effectively while reducing the risk of misuse and harm.’
[post_title] => Common analgesics may be contributing to antimicrobial resistance
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[post_content] => On Monday (25 August) PSA introduced the new crop of leaders for the Early Career Pharmacist (ECP) Community of Specialty Interest (CSI) – a dynamic group dedicated to empowering the next generation of pharmacists across Australia.
Dr Ayomide Ogundipe MPS has been re-appointed for a third term as Chair of the Early Career Pharmacist Leadership Group and ECP Director on the PSA National Board.
For the first time the ECP CSI will also include a representative practising in the Northern Territory.
The 2025-26 Early Career Pharmacists CSI is led by:
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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] => New research has found that ibuprofen and paracetamol may be contributing to antimicrobial resistance – particularly when used in combination.
Researchers from the University of South Australia conducted a study in residential aged care facilities (RACFs) on antimicrobial resistance, looking at the interactions between organisms such as Escherichia coli, non-antibiotic medicines and the broad-spectrum antibiotic ciprofloxacin, Lead Researcher Associate Professor Rietie Venter told Australian Pharmacist.
‘We also looked at an antibiotic-sensitive microorganism we isolated from a resident and we treated this microorganism with nine medications which are frequently used in the older population,’ she said.
The microorganisms were treated with the medicines – including ibuprofen, diclofenac, paracetamol, furosemide, metformin, atorvastatin, tramadol, temazepam and pseudoephedrine – both individually and in combinations of two.
Paracetamol and ibuprofen were found to increase ciprofloxacin resistance in this gut bacterium separately, and even more so when combined.
‘When bacteria were exposed to ciprofloxacin alongside ibuprofen and paracetamol, they developed more genetic mutations than with the antibiotic alone, helping them grow faster and become highly resistant,’ A/Prof Venter said.
‘Worryingly, the bacteria were not only resistant to the antibiotic ciprofloxacin, but increased resistance was also observed to multiple other antibiotics from different classes.’
How do paracetamol and ibuprofen increase antimicrobial resistance?
Sequencing in follow-up studies revealed how the organism acquired mutations, A/Prof Venter said.
‘Evolution is turbocharged in these little microbes; under ideal conditions, organisms like the one we used double every 20 minutes,’ she said.
‘If they get stressed by the addition of paracetamol and an antibiotic, they mutate. While some of those mutations make them more vulnerable, many might actually make them resistant.’
Mutations conferring resistance to ciprofloxacin were identified, along with efflux pumps – membrane proteins that expel antibiotics before they can reach their targets.
‘When used in combination, a synergy between the two medicines causes increased mutations, leading to higher levels of resistance.’
On a positive note, none of the other nine medicines analysed in the research increased antimicrobial resistance in the gut bacteria.
‘None of the other medications, when combined with ibuprofen, were worse than ibuprofen by itself,’ she said.
Are there certain populations who could be more at risk?
Older Australians, particularly those in RACFs, are a reservoir for antimicrobial resistance.
‘Older people are more likely to be prescribed multiple medications – not just antibiotics, but also medicines for pain, sleep, or blood pressure – making them an ideal breeding ground for gut bacteria to become resistant to antibiotics,’ A/Prof Venter.
While more research is needed before any policy change may be considered, A/Prof Venter thinks it’s important to understand why these analgesics are being taken together and to consider alternative options.
‘We would love to do more research to see if there is a way we can exchange an [analgesic] for another pain medication that doesn't cause the enhanced antimicrobial resistance, or if there's a certain time between taking them that’s better.’
What advice should pharmacists provide to patients?
It’s common for antibiotics to be combined with over-the-counter analgesics. For example, a woman with a urinary tract infection who is taking an antibiotic might also take an analgesic for pain relief, or a child with a bacterial infection such as tonsillitis who is prescribed azithromycin could be administered ibuprofen and paracetamol to manage a high fever.
The research provides an opportunity for pharmacists to raise awareness among patients about the risks of antimicrobial resistance, A/Prof Venter said.
‘It’s well known that the use of antibiotics may cause antimicrobial resistance,’ she said. ‘But it’s not considered that these frequently used medications can also increase antimicrobial resistance.’
The paracetamol scheduling changes introduced earlier this year are also an important step in building public awareness that these medicines are not as harmless as they might appear, A/Prof Venter believes.
‘Compared to many other medications, people tend to think of [paracetamol and ibuprofen] as completely harmless,’ she said. ‘So strategies such as smaller pack sizes can lead to changes in behaviour.’
PSA’s Medicine safety: Child and adolescent care report found that pharmacists have an increasing role in helping patients use common analgesics safely, with approximately 16% of pharmaceutical poisoning hospital admissions in children under 5 years of age being attributed to paracetamol.
‘By limiting the maximum pack sizes of paracetamol, we are opening the door to have a conversation about the risks and benefits of these medicines – both in the pharmacy and at home – and take steps as a community to promote the safe use of medicines,’ said PSA National President Associate Professor Fei Sim FPS.
‘By involving pharmacists in the supply of paracetamol in larger pack sizes, we strike the right balance between access and safety, giving pharmacists the opportunity to help patients manage their pain effectively while reducing the risk of misuse and harm.’
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[post_content] => On Monday (25 August) PSA introduced the new crop of leaders for the Early Career Pharmacist (ECP) Community of Specialty Interest (CSI) – a dynamic group dedicated to empowering the next generation of pharmacists across Australia.
Dr Ayomide Ogundipe MPS has been re-appointed for a third term as Chair of the Early Career Pharmacist Leadership Group and ECP Director on the PSA National Board.
For the first time the ECP CSI will also include a representative practising in the Northern Territory.
The 2025-26 Early Career Pharmacists CSI is led by:
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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
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