Georgia Clarke
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[post_content] => Women of reproductive age using glucagon-like peptide-1 receptor agonists (GLP-1 RAs) could be at risk of unintended pregnancy, and may be unaware of associated risks to pregnancy and unborn babies.
A new study by Flinders University, which examined records from more than 1.6 million women aged 18–49 who attended general practice between 2011 and 2022, found that only one in five (21%) of those with first prescribing of GLP-1 RAs had documented contraceptive use.
The study also found that most prescriptions for GLP-1 RAs are now issued to women without diabetes. In 2022 alone, more than 6,000 women began treatment on GLP-1 RAs, and over 90% of those did not have a type 2 diabetes diagnosis.
[caption id="attachment_30483" align="alignright" width="300"]
Associate Professor Luke Grzeskowiak[/caption]
Participants were tracked at the initial stages of GLP-1 RA therapy, with the research team looking at documented evidence of pregnancies over a 6-month period, said lead author and pharmacist, Associate Professor Luke Grzeskowiak.
‘[While] limited to data from GP records, one in 25 women aged 18 to 34 years had a documented pregnancy at the time of prescribing,’ he said.
‘There will also be pregnancies that the GP might not be aware of, so if anything, what we're expecting is that this is an underestimate of what's truly happening.’
Those who were prescribed concurrent contraception were 50% less likely to have a documented pregnancy.
‘So we've got clear evidence that contraceptive use at the time of initiating these medicines reduces the risk of pregnancies occurring,’ A/Prof Grzeskowiak said.
Why does GLP-1 RA use increase pregnancy risk?
There are two key reasons: first, it is ‘well established’ that weight loss can improve fertility.
‘Because we know these medicines are very effective at promoting weight loss, it's highly plausible that they could improve fertility through that mechanism,’ A/Prof Grzeskowiak said.
There have also been concerns that GLP-1 RAs might impact absorption of the oral contraceptive pill.
In June 2025, the UK’s Medicines and Healthcare products Regulatory Agency issued a regulatory warning following case reports of unexpected pregnancies associated with GLP-1 RA use.
‘A detailed review [revealed] that the strongest evidence was around potential interaction between tirzepatide and reduced effectiveness of oral contraception,’ A/Prof Grzeskowiak said.
To date, evidence regarding interactions between GLP-1 RAs and the oral contraceptive pill is limited.
‘So the general recommendations around that regulatory warning were for those relying on oral contraceptive methods to also consider using a barrier method,’ he said.
What are the congenital risk factors?
The research also considered potential harms associated with GLP-1 RAs in pregnancy. Key concerns were taken from a University of Amsterdam review of animal studies, cited in the Flinders University study.
‘In animals, use of GLP-1 RAs [in pregnancy] led to reductions in foetal growth, impairments in bone development and impaired maternal weight gain,’ A/Prof Grzeskowiak said.
At this stage, the human data are more reassuring.
‘The studies that have been done have not shown an increased risk of birth defects,’ he said. ‘But they are still relatively limited in terms of numbers, and we don't have an examination of the full range of pregnancy outcomes yet,’ he said.
Due to this uncertainty, an abundance of caution is advised.
‘The recommendations are to not use these medicines during pregnancy, and to avoid the potential for them to be used during pregnancy accidentally,’ A/Prof Grzeskowiak said. ‘So it’s important to have a plan around concurrent contraception use, high-quality pre-conception care, and ensure that where pregnancies are planned, everything has been done to optimise pregnancy outcomes.’
What should pharmacists advise patients?
Dispensing GLP-1 RAs provides important opportunities for pharmacists to talk to patients about reproductive health.
For example, when dispensing tirzepatide, access to dispensing data on contraceptive methods enables pharmacists to raise awareness of the potential interaction by initiating an open and unassuming conversation, A/Prof Grzeskowiak said.
‘Having a conversation about how that might be addressed means patients can make an informed decision,’ he said. ‘It might mean changing contraceptive methods or [referring] them back to the GP for a conversation. Or it may be that they're using contraceptives for non-contraceptive purposes such as acne [management], so there’s a low risk of pregnancy.’
The initiation of therapy is the ideal time to discuss potential risks.
‘That way people know what to expect in terms of the medicines,’ he said.
When commencing GLP-1 RAs, patients may also experience profound gastrointestinal adverse effects, including vomiting or diarrhoea.
‘That in itself can reduce the effectiveness of oral contraception, regardless of any other interactions,’ A/Prof Grzeskowiak said. ‘So people should be aware of the side effects of what to expect when starting this and how it might impact on other treatments that they're using.’
Pharmacists have an important role in engaging patients in conversations about reproductive health, particularly contraception.
‘Not everyone feels comfortable asking those questions, but there are good training resources, particularly through PSA, around improving pharmacists’ comfort with having those conversations, including around the different types of contraceptive methods,’ he said.
‘It's one thing to start the conversation, but you also need to be armed with various information to be able to continue it, or at least identify when to refer patients back to their medical practitioner or another [healthcare practitioner] to provide that detailed advice.’
[post_title] => GLP-1 RAs found to pose pregnancy risks
[post_excerpt] => Women of reproductive age using GLP-1 RAs could be at risk of unintended pregnancy, and unaware of the risks to pregnancy and unborn babies.
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[post_content] => In August 2025, I had the privilege of attending the International Pharmaceutical Students’ Federation (IPSF) World Congress in Nairobi, Kenya.
The theme of this year’s congress, Advancing Pharmacy Education and Practice for Global Health Impact, was reflected throughout the week in discussions, panels and workshops.
Thanks to the generous support of PSA and the National Australian Pharmacy Students’ Association (NAPSA), I was able to represent both Australia and New Zealand as the sole Official Delegate at the General Assembly. Without their support, our countries would not have had a voice.
Leaders in training
Before the official start of World Congress, I participated in the Leaders in Training (LiT) program, where I became an Alpha Trainer after reaching the required hours. I ran workshops focused on developing soft skills for future leaders, guiding students through sessions on motivation, feedback and evaluation.
This was a rewarding opportunity to share knowledge, strengthen my own skills, and witness the energy and passion of upcoming leaders.
Once the Congress began, much of my time was spent in the General Assembly, carrying the responsibility of casting votes and ensuring the perspectives of
students from both Australia and New Zealand were heard. Being the only delegate from our area made me realise just how vital the support of PSA and NAPSA was.
Technology and access
Among the many events I attended, one highlight was a panel discussion on the use of AI in healthcare. This session offered a fascinating look at both the opportunities and the challenges of integrating AI into healthcare delivery.
I also gained insight into the industrial pharmacy sector in Kenya, as well as the broader challenges faced by healthcare in Nairobi. These experiences expanded my understanding of the global landscape of pharmacy and reminded me of the inequities that continue to exist in access to medicines and resources.
The Congress also gave me the chance to reconnect with peers from around the world, including those I had previously worked with as NAPSA’s Contact Person. It was valuable to strengthen existing connections and build friendships with students who share the same interest in pharmacy.World Congress was a once-in-a-lifetime experience; one I hope more Australian pharmacy students will pursue in the future.
Start local, go global
IPSF represents over 500,000 pharmacy students worldwide, yet Australia’s presence remains small. I want to change that by encouraging more students to get involved and take advantage of the opportunities IPSF offers.
The first step is to become involved in your local student branch, which can then open doors to national opportunities through NAPSA and, eventually, to international representation.
I still remember attending my first IPSF conference alone and feeling nervous, only to be welcomed immediately by the IPSF Asia Pacific Regional Office (APRO), who embraced me as part of their community. The warmth and inclusivity I experienced then continues to inspire me, and I encourage others to take the same leap.
People want to connect with you, and IPSF provides a space where friendships, networks, and professional growth come naturally.
Looking ahead, the next IPSF events will be the Asia Pacific Pharmaceutical Symposium (APPS) in Indonesia and the World Congress in Thailand. I would strongly encourage pharmacy students to consider attending these future events, as they are transformative experiences that broaden horizons, deepen understanding and build lifelong networks.
Pathways Ahead
I am deeply grateful to PSA for their monumental support in making my attendance possible. With travel costs being high, it would have been impossible for me to attend without their sponsorship.
Because of their generosity, Australia and New Zealand were represented at the General Assembly, and our perspectives contributed to global discussions.
I also want to thank NAPSA for their support, which made it more feasible for me to attend in my role as Official Delegate. Their backing ensured that I was able to fulfil my duties and give our members a voice on the international stage.
Attending World Congress 2025 in Nairobi was an unforgettable experience that strengthened my leadership skills, broadened my understanding of global healthcare, and connected me with pharmacy students from across the world.
Most importantly, it reminded me of the importance of ensuring Australia and New Zealand are active participants in shaping the future of our profession.
To PSA and NAPSA, thank you once again for making this possible. To my fellow pharmacy students, I encourage you to take that first step, get involved, and see where it leads. You might just find yourself representing our country on the world stage one day.
[post_title] => A voice for Australia and New Zealand at IPSF 2025
[post_excerpt] => Australia and New Zealand had a voice at the IPSF World Congress, influencing discussions on education, practice and global health.
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[title_attribute] => A voice for Australia and New Zealand at IPSF 2025
[title] => A voice for Australia and New Zealand at IPSF 2025
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[post_content] => A blistering opening plenary session at the FIP Congress last week has challenged policymakers and health professionals alike to act to slow the advance of antimicrobial resistance (AMR).
Mr Michele Cecchini, Head of Public Health, Organisation for Economic Co-operation and Development (OECD), worked through startling data showing the cost of AMR globally – in dollars, and in years of life lost.
The high price of insufficient action on AMR
The OECD has crunched the numbers, and the statistics are startling.
AMR is currently shortening life expectancy by an average of 1.8 years globally – 1.7 years for people in high-income countries, or 2.5 years for people in low-income countries.
This is represented in 79,000 people dying due to resistant infections across 34 OECD, European Union and European Economic Area counties – corresponding to 2.4 times the number of deaths due to tuberculosis, influenza and HIV/AIDS combined in 2020.
The financial burden on the health system is similarly staggering, with global annual costs totalling $US 412 billion.
Once lost productivity and loss of income costs are added in, this cost balloons to $US 850 billion annually – about the same size of Poland’s economy.
Bold action is required
Modelling by the OECD has shown that meaningful action is achievable – albeit with a substantial price tag.
To reduce AMR-related deaths by 10%, six actions are required:
- All countries need to have national AMR action plans and 60% of countries commit a budget
- 90% of countries should meet WHO’s minimum infection prevention and control programs at a national level
- All countries need to report surveillance data on AMR and antimicrobial use
- Meaningful reduction in antimicrobial use is taken in agrifood systems
- Strengthened actions to prevent and address the discharge of antimicrobials into the environment
- Mechanisms to support research and development to address AMR should be promoted.
The cost of these initiatives globally is estimated to be $US 52 billion annually – equivalent to 0.5% of the global health budget.
‘The World Bank told us this is a rounding error [in the context of health spending]. This is not an amount of money which cannot be mobilised,’ Mr Cecchini said.
These sentiments were echoed by the Danish Minister for the Interior and Health Sophie Løhde.
‘To tackle [AMR], we need to work much closer together, and your role as pharmacists and life science professionals is key,’ said Minister Løhde at the first plenary session of the 2025 FIP world congress last week. ‘We need your expertise to develop new antimicrobials in the most prudent and effective manner, and to inform and educate our citizens when you meet them in pharmacies all over the world.’
The FIP Copenhagen Declaration on Antimicrobial Resistance, signed by 79 organisations – including The Pharmaceutical Society of Australia – took place on 1 September 2025.
The FIP Declaration outlines clear priorities to address AMR, including global partnership building, promoting vaccination and rational antimicrobial use, protecting medicine supply chains, and advancing evidence on stewardship and outcomes.
[post_title] => OECD sounds the alarm on antimicrobial resistance
[post_excerpt] => A blistering session at the FIP Congress challenged policymakers and health professionals to slow the advance of antimicrobial resistance.
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[post_content] => A study led by Flinders University and the Southern Adelaide Local Health Network shows that the anti-rheumatic medicine methotrexate significantly reduces blood pressure in some patients compared with sulfasalazine – the first clear evidence of this effect in patients newly diagnosed with rheumatoid arthritis (RA).
The common autoimmune disease occurs in around one in 100 people, leading to inflammation and pain in the connective tissue of the joints.
The inflammation caused by RA contributes to high blood pressure by damaging blood vessels, prompting rheumatologists to realise that people with RA don't typically die because of their condition, said lead researcher Professor Arduino Mangoni, Head of Pharmacology at Flinders University College of Medicine and Public Health.
[caption id="attachment_30469" align="alignright" width="216"]
Professor Arduino Mangoni[/caption]
‘The main reason people with RA die is because they have a cardiovascular event, such as a myocardial infarction or stroke,’ he said. ‘And this is often because of an excess prevalence of hypertension in these individuals.’
High blood pressure can significantly shorten the life expectancy of people with RA.
‘An epidemiological study quantifying the burden of cardiovascular disease in people with RA concluded that the increased risk imparted by rheumatoid arthritis was similar to diabetes,’ Prof Mangoni added.
What impact did methotrexate have on blood pressure?
Methotrexate is not the only anti-rheumatic medicine that can reduce hypertension, with hydroxychloroquine also being shown to be potentially protective against atherosclerosis, Prof Mangoni said.
‘So we wanted to use the comparator, sulfasalazine, that was still an anti-inflammatory drug [to test in] people with RA, but with very neutral effects on blood pressure,’ he said.
Among patients with RA, the blood pressure of those taking methotrexate differed by an average of 7.4 mmHg compared with people taking sulfasalazine.
‘Most tablets for blood pressure, when given at a moderate to high dose, will have an effect on blood pressure of between 5–10 mmHg – which is normally, at the population level, associated with the reduction in cardiovascular risk of around 10–15%,’ Prof Mangoni said. ‘So by extrapolation, methotrexate compares very well to a traditional antihypertensive medication.’
In patients with RA who don’t have hypertension, methotrexate could also have a preventative effect.
‘That was very well shown in our study, with only a proportion of [participants] having hypertension,’ Prof Mangoni said.
The medicine can also be assumed to lower cardiovascular risk.
‘If there is a positive effect on blood pressure, consequently, you should have a reduced risk of myocardial infarction and stroke, as well as potentially heart failure,’ he said.
Although the impacts of methotrexate on these indications were not specifically tested in the research, the observational results are promising.
‘They are in line with increasing clinical evidence from epidemiological studies that the use of methotrexate is associated with a reduced risk of heart failure, heart attacks and strokes in people with RA,’ Prof Mangoni said.
Is there potential for a new indication?
In people who have both hypertension and RA, there’s a possibility that medicine regimens could change, Prof Mangoni said.
‘The future should address whether the use of methotrexate in this population can allow modification of antihypertensive medications to have a different treatment regimen,’ he said.
‘Methotrexate could also be an adjuvant, but this can only be tested in adequately designed prospective studies.’
Beyond patients with RA, it’s possible that methotrexate might also be indicated for patients with hypertension in the not-too-distant future. But Prof Mangoni concedes this is an ‘increasingly debated topic’.
‘There has only been one study, published 5 years ago, that looks at the effects of low-dose methotrexate on cardiovascular risk in people without RA,’ he said.
‘The idea was that by giving methotrexate to this population that already has a high pro-inflammatory burden, you would actually reduce the risk of atherosclerosis.’
While this study didn’t yield positive results, there are a few reasons behind this that warrant further exploration. The participants in both the intervention and placebo groups did not have particularly high inflammatory markers, and both groups also received folic acid.
‘Folic acid is given together with methotrexate because it has been shown to reduce the toxicity of [the medicine],’ Prof Mangoni said. ‘However, folic acid can also be protective against atherosclerosis. So the fact that it was also given to the placebo arm might have somewhat diluted the protective effects of methotrexate in this trial.’
To best assess the effects in future research, he suggests a trial design comprising three arms: methotrexate plus folic acid, folic acid alone and the placebo group.
‘I suspect that in the future, methotrexate might have value in people without autoimmune diseases, but with a high inflammatory burden,’ he said.
What role does genetics play in the success of therapy?
Another key finding from the research is that methotrexate may not be the right fit for everyone. The medicine has a complex pharmacology, with several mechanisms facilitating its uptake and storage in cells, Prof Mangoni said.
‘Sometimes it is excreted by the cell, so it [reaches] different targets, with each of these targets potentially having genetic variations,’ he said.
Research has shown that there are several genetic polymorphisms that render people more or less responsive to methotrexate in terms of blood pressure reduction.
‘Interestingly, the polymorphisms that we observed [in our research] are different from the polymorphisms that have been previously described,’ Prof Mangoni said.
‘So future research should look for personalised treatment strategies to identify whether these polymorphisms are similar or different to other polymorphisms responsible for blood pressure reduction – and potentially the reduced risk of atherosclerosis.’
In further research, Prof Mangoni is keen to confirm the role of polymorphisms in lowering blood pressure after treatment with methotrexate, with pharmacogenomics determining who is a suitable candidate for the medicine.
‘The idea is to have a comprehensive genetic panel in people who are considered for treatment for methotrexate to determine from the very beginning who is more or less likely to respond,’ he said.
‘The next step is determining whether these polymorphisms could be translated into a non-RA population to see whether this can be tailored to the treatment of methotrexate in these [people].’
[post_title] => Blood pressure benefits seen with methotrexate treatment
[post_excerpt] => New research links methotrexate to a fall in blood pressure. This expert thinks it could lower cardiovascular risk in the general population.
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[post_content] => Parents have reported persistent anxiety about asthma attacks while children miss out. Pharmacists can help to pivot care from treating flare-ups to stopping them.
Australian families are still living with the hidden emotional toll of childhood asthma – even when they believe control is ‘good enough’.
New research, released as part of the launch of Asthma Australia's new multi-year 'Attack Asthma' campaign found that most (60%) of the parents surveyed live with constant anxiety about the next asthma attack, while 57% worry about their child missing out on normal activities.
A reactive approach to asthma management appears to be driving these concerns, with more than half (58%) of parents revealing their child does not use a preventer daily. More than two-thirds (66%) who notice wheeze, cough or breathlessness dismiss these as symptoms of a lingering cold, virus or allergy, rather than asthma. And even when asthma is suspected, nearly a third (30%) still don’t pursue a diagnosis, assuming the symptoms aren’t severe enough.
This National Asthma Week (1–7 September), Australian Pharmacist sat down with Dr Chris Pearce – a Melbourne-based GP who’s on the board of Asthma Australia – about how pharmacists can help to flip the narrative from ‘asthma attack’ to ‘attack asthma’.
Shifting the perspective from reactive to proactive
The difference between asthma and many other chronic conditions is its variability.
So for many decades, asthma care typically began with a reliever (usually a short-acting beta-2 agonist (SABA) as the first step for symptom relief.
‘The asthma action plans in times past emphasised that if you get an [attack] use [salbutamol] Ventolin,’ Dr Pearce said. ‘But we've now moved on to encourage the increased use of preventers to stop the acute attacks.’
The purpose of this strategy is to lessen the impact of asthma on children, along with the parental anxiety that goes with it.
‘The classic example is sport where we used to say, “make sure you've got a blue puffer and use it if you get a bit wheezy”,’ he said.
Even without obvious symptoms such as coughing and shortness of breath, these children were likely experiencing mild symptoms such as tiredness, Dr Pearce said.
‘They weren't reaching their full potential because they had subclinical symptoms,’ he said.
When dispensing preventers and supplying salbutamol, pharmacists can help to transform the approach to asthma management from reactive to proactive.
‘What you do in the intervals between attacks, that’s more important than how you manage an actual attack,’ Dr Pearce said.
‘I say to people, “This is a disease that you have all the time, and we need to manage it all the time because we're trying to maximise your child's potential, rather than just treating attacks.”
Identifying undiagnosed or uncontrolled asthma
Pharmacists are often the first port of call when children experience a minor ailment, Dr Pearce said.
‘That’s when parents front up to the pharmacy and say, “my child has a cough” or “my child's a bit wheezy”,’ he said.
But if you dig a little deeper, you can often unearth the root cause.
‘If you ask a few questions rather than taking it at face value, it might be revealed that they haven't got a runny nose or a temperature, and it could actually be a manifestation of asthma,’ he said.
‘If a child tends to get a cough with every cold and they're coming in for the cough syrup each and every time, that's a bit of a red flag.’
When parents of children who do have confirmed asthma buy salbutamol over-the-counter, pharmacists should monitor how often they purchase it and recommend a formal assessment where appropriate.
‘It’s not about refusing people who want to buy Ventolin, but just planting the seed that a more formal assessment is a good thing,’ Dr Pearce said.
Another indicator can lie in My Health Record.
‘You might see that, unbeknownst to you, there's been a couple of scripts of oral prednisolone from the local hospital,’ he said.
Picking up on poor inhaler technique
Even when patients are using preventer medicines, the wrong inhaler technique can impact treatment outcomes.
This can include anything from not using a spacer when it’s deemed appropriate or not pointing the inhaler in the right direction.
‘I've seen inhalers held six inches away from the mouth,’ Dr Pearce said. ‘I've also seen people who use other devices such as Turbuhalers not click the dial, so they're just inhaling air,’ he said.
When a preventer is first prescribed, Dr Pearce advises pharmacists to demonstrate the correct technique.
‘Then there's a role, especially in children, to check their technique a couple of times a year,’ he said. ‘You can also get the parent to bring the spacer in to check if it’s cracked and broken.’
In children with mild and intermittent asthma, pharmacists can also check whether the preventer dose is appropriate.
‘They grow, but [sometimes] their dose doesn't,’ he said. ‘So you need to occasionally rethink whether they're getting the right dose, and suggest they should go to the GP to get it reviewed.’
Improving adherence and long-term management
Pharmacists can help to reinforce strategies to improve adherence, Dr Pearce said.
‘One of the things about regular maintenance is that it's regular, so it gets into the routine,’ he said. ‘So if you're going to use an inhaler and spacer in the morning and night, having it when you get up and when you go to bed is easier to remember than having to pack it in your school bag every day,’ he said.
Asthma patterns are individual and can vary seasonally. So in all asthma cases, reviewing the pattern of disease is key.
‘For some people, spring has no impact, whereas for others it’s a complete disaster,’ Dr Pearce said.
‘For those patients, my recommendation would be to double the preventer dose for the next couple of months so they continue to be well – regardless of what's going on with the weather.
‘We're keen on a review every 6 months, even in stable children, just to make sure that everyone's keeping on top of it.’
For parents who are concerned about the medication burden of daily preventer use, Dr Pearce said it’s important to emphasise the risks and benefits.
‘There are some side effects from taking inhaled corticosteroids on a regular basis, but they're unusual, and if they do occur they are mild – much less than what you would get from several courses of oral corticosteroids over a year when asthma is not controlled,’ he said.
It’s also important for parents to balance the potential adverse effects from long-term corticosteroid use in a child with mild and untreated asthma, who's not able to concentrate at school.
‘If they’re not able to concentrate at school or perform at their best in sport, in my view the benefits outweigh the risks,’ Dr Pearce said.
It’s also helpful to remind parents that the better controlled their child’s asthma is, the lower their dose of inhaled corticosteroids will need to be.
‘The old asthma action plans used to say, “use your Ventolin when you need it. And if you get sick, take a big dose of your inhaled corticosteroids”,’ Dr Pearce said. ‘But if we use a small dose regularly, it’s much better tolerated by the body.’
[post_title] => The hidden toll of ‘good enough’ asthma control
[post_excerpt] => Parents have reported persistent anxiety about asthma attacks. Pharmacists can help to pivot care from treating flare-ups to stopping them.
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[title_attribute] => The hidden toll of ‘good enough’ asthma control
[title] => The hidden toll of ‘good enough’ asthma control
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[post_content] => Women of reproductive age using glucagon-like peptide-1 receptor agonists (GLP-1 RAs) could be at risk of unintended pregnancy, and may be unaware of associated risks to pregnancy and unborn babies.
A new study by Flinders University, which examined records from more than 1.6 million women aged 18–49 who attended general practice between 2011 and 2022, found that only one in five (21%) of those with first prescribing of GLP-1 RAs had documented contraceptive use.
The study also found that most prescriptions for GLP-1 RAs are now issued to women without diabetes. In 2022 alone, more than 6,000 women began treatment on GLP-1 RAs, and over 90% of those did not have a type 2 diabetes diagnosis.
[caption id="attachment_30483" align="alignright" width="300"] Associate Professor Luke Grzeskowiak[/caption]
Participants were tracked at the initial stages of GLP-1 RA therapy, with the research team looking at documented evidence of pregnancies over a 6-month period, said lead author and pharmacist, Associate Professor Luke Grzeskowiak.
‘[While] limited to data from GP records, one in 25 women aged 18 to 34 years had a documented pregnancy at the time of prescribing,’ he said.
‘There will also be pregnancies that the GP might not be aware of, so if anything, what we're expecting is that this is an underestimate of what's truly happening.’
Those who were prescribed concurrent contraception were 50% less likely to have a documented pregnancy.
‘So we've got clear evidence that contraceptive use at the time of initiating these medicines reduces the risk of pregnancies occurring,’ A/Prof Grzeskowiak said.
Why does GLP-1 RA use increase pregnancy risk?
There are two key reasons: first, it is ‘well established’ that weight loss can improve fertility.
‘Because we know these medicines are very effective at promoting weight loss, it's highly plausible that they could improve fertility through that mechanism,’ A/Prof Grzeskowiak said.
There have also been concerns that GLP-1 RAs might impact absorption of the oral contraceptive pill.
In June 2025, the UK’s Medicines and Healthcare products Regulatory Agency issued a regulatory warning following case reports of unexpected pregnancies associated with GLP-1 RA use.
‘A detailed review [revealed] that the strongest evidence was around potential interaction between tirzepatide and reduced effectiveness of oral contraception,’ A/Prof Grzeskowiak said.
To date, evidence regarding interactions between GLP-1 RAs and the oral contraceptive pill is limited.
‘So the general recommendations around that regulatory warning were for those relying on oral contraceptive methods to also consider using a barrier method,’ he said.
What are the congenital risk factors?
The research also considered potential harms associated with GLP-1 RAs in pregnancy. Key concerns were taken from a University of Amsterdam review of animal studies, cited in the Flinders University study.
‘In animals, use of GLP-1 RAs [in pregnancy] led to reductions in foetal growth, impairments in bone development and impaired maternal weight gain,’ A/Prof Grzeskowiak said.
At this stage, the human data are more reassuring.
‘The studies that have been done have not shown an increased risk of birth defects,’ he said. ‘But they are still relatively limited in terms of numbers, and we don't have an examination of the full range of pregnancy outcomes yet,’ he said.
Due to this uncertainty, an abundance of caution is advised.
‘The recommendations are to not use these medicines during pregnancy, and to avoid the potential for them to be used during pregnancy accidentally,’ A/Prof Grzeskowiak said. ‘So it’s important to have a plan around concurrent contraception use, high-quality pre-conception care, and ensure that where pregnancies are planned, everything has been done to optimise pregnancy outcomes.’
What should pharmacists advise patients?
Dispensing GLP-1 RAs provides important opportunities for pharmacists to talk to patients about reproductive health.
For example, when dispensing tirzepatide, access to dispensing data on contraceptive methods enables pharmacists to raise awareness of the potential interaction by initiating an open and unassuming conversation, A/Prof Grzeskowiak said.
‘Having a conversation about how that might be addressed means patients can make an informed decision,’ he said. ‘It might mean changing contraceptive methods or [referring] them back to the GP for a conversation. Or it may be that they're using contraceptives for non-contraceptive purposes such as acne [management], so there’s a low risk of pregnancy.’
The initiation of therapy is the ideal time to discuss potential risks.
‘That way people know what to expect in terms of the medicines,’ he said.
When commencing GLP-1 RAs, patients may also experience profound gastrointestinal adverse effects, including vomiting or diarrhoea.
‘That in itself can reduce the effectiveness of oral contraception, regardless of any other interactions,’ A/Prof Grzeskowiak said. ‘So people should be aware of the side effects of what to expect when starting this and how it might impact on other treatments that they're using.’
Pharmacists have an important role in engaging patients in conversations about reproductive health, particularly contraception.
‘Not everyone feels comfortable asking those questions, but there are good training resources, particularly through PSA, around improving pharmacists’ comfort with having those conversations, including around the different types of contraceptive methods,’ he said.
‘It's one thing to start the conversation, but you also need to be armed with various information to be able to continue it, or at least identify when to refer patients back to their medical practitioner or another [healthcare practitioner] to provide that detailed advice.’
[post_title] => GLP-1 RAs found to pose pregnancy risks
[post_excerpt] => Women of reproductive age using GLP-1 RAs could be at risk of unintended pregnancy, and unaware of the risks to pregnancy and unborn babies.
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[post_content] => In August 2025, I had the privilege of attending the International Pharmaceutical Students’ Federation (IPSF) World Congress in Nairobi, Kenya.
The theme of this year’s congress, Advancing Pharmacy Education and Practice for Global Health Impact, was reflected throughout the week in discussions, panels and workshops.
Thanks to the generous support of PSA and the National Australian Pharmacy Students’ Association (NAPSA), I was able to represent both Australia and New Zealand as the sole Official Delegate at the General Assembly. Without their support, our countries would not have had a voice.
Leaders in training
Before the official start of World Congress, I participated in the Leaders in Training (LiT) program, where I became an Alpha Trainer after reaching the required hours. I ran workshops focused on developing soft skills for future leaders, guiding students through sessions on motivation, feedback and evaluation.
This was a rewarding opportunity to share knowledge, strengthen my own skills, and witness the energy and passion of upcoming leaders.
Once the Congress began, much of my time was spent in the General Assembly, carrying the responsibility of casting votes and ensuring the perspectives of
students from both Australia and New Zealand were heard. Being the only delegate from our area made me realise just how vital the support of PSA and NAPSA was.
Technology and access
Among the many events I attended, one highlight was a panel discussion on the use of AI in healthcare. This session offered a fascinating look at both the opportunities and the challenges of integrating AI into healthcare delivery.
I also gained insight into the industrial pharmacy sector in Kenya, as well as the broader challenges faced by healthcare in Nairobi. These experiences expanded my understanding of the global landscape of pharmacy and reminded me of the inequities that continue to exist in access to medicines and resources.
The Congress also gave me the chance to reconnect with peers from around the world, including those I had previously worked with as NAPSA’s Contact Person. It was valuable to strengthen existing connections and build friendships with students who share the same interest in pharmacy.World Congress was a once-in-a-lifetime experience; one I hope more Australian pharmacy students will pursue in the future.
Start local, go global
IPSF represents over 500,000 pharmacy students worldwide, yet Australia’s presence remains small. I want to change that by encouraging more students to get involved and take advantage of the opportunities IPSF offers.
The first step is to become involved in your local student branch, which can then open doors to national opportunities through NAPSA and, eventually, to international representation.
I still remember attending my first IPSF conference alone and feeling nervous, only to be welcomed immediately by the IPSF Asia Pacific Regional Office (APRO), who embraced me as part of their community. The warmth and inclusivity I experienced then continues to inspire me, and I encourage others to take the same leap.
People want to connect with you, and IPSF provides a space where friendships, networks, and professional growth come naturally.
Looking ahead, the next IPSF events will be the Asia Pacific Pharmaceutical Symposium (APPS) in Indonesia and the World Congress in Thailand. I would strongly encourage pharmacy students to consider attending these future events, as they are transformative experiences that broaden horizons, deepen understanding and build lifelong networks.
Pathways Ahead
I am deeply grateful to PSA for their monumental support in making my attendance possible. With travel costs being high, it would have been impossible for me to attend without their sponsorship.
Because of their generosity, Australia and New Zealand were represented at the General Assembly, and our perspectives contributed to global discussions.
I also want to thank NAPSA for their support, which made it more feasible for me to attend in my role as Official Delegate. Their backing ensured that I was able to fulfil my duties and give our members a voice on the international stage.
Attending World Congress 2025 in Nairobi was an unforgettable experience that strengthened my leadership skills, broadened my understanding of global healthcare, and connected me with pharmacy students from across the world.
Most importantly, it reminded me of the importance of ensuring Australia and New Zealand are active participants in shaping the future of our profession.
To PSA and NAPSA, thank you once again for making this possible. To my fellow pharmacy students, I encourage you to take that first step, get involved, and see where it leads. You might just find yourself representing our country on the world stage one day.
[post_title] => A voice for Australia and New Zealand at IPSF 2025
[post_excerpt] => Australia and New Zealand had a voice at the IPSF World Congress, influencing discussions on education, practice and global health.
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[title_attribute] => A voice for Australia and New Zealand at IPSF 2025
[title] => A voice for Australia and New Zealand at IPSF 2025
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[post_content] => A blistering opening plenary session at the FIP Congress last week has challenged policymakers and health professionals alike to act to slow the advance of antimicrobial resistance (AMR).
Mr Michele Cecchini, Head of Public Health, Organisation for Economic Co-operation and Development (OECD), worked through startling data showing the cost of AMR globally – in dollars, and in years of life lost.
The high price of insufficient action on AMR
The OECD has crunched the numbers, and the statistics are startling.
AMR is currently shortening life expectancy by an average of 1.8 years globally – 1.7 years for people in high-income countries, or 2.5 years for people in low-income countries.
This is represented in 79,000 people dying due to resistant infections across 34 OECD, European Union and European Economic Area counties – corresponding to 2.4 times the number of deaths due to tuberculosis, influenza and HIV/AIDS combined in 2020.
The financial burden on the health system is similarly staggering, with global annual costs totalling $US 412 billion.
Once lost productivity and loss of income costs are added in, this cost balloons to $US 850 billion annually – about the same size of Poland’s economy.
Bold action is required
Modelling by the OECD has shown that meaningful action is achievable – albeit with a substantial price tag.
To reduce AMR-related deaths by 10%, six actions are required:
- All countries need to have national AMR action plans and 60% of countries commit a budget
- 90% of countries should meet WHO’s minimum infection prevention and control programs at a national level
- All countries need to report surveillance data on AMR and antimicrobial use
- Meaningful reduction in antimicrobial use is taken in agrifood systems
- Strengthened actions to prevent and address the discharge of antimicrobials into the environment
- Mechanisms to support research and development to address AMR should be promoted.
The cost of these initiatives globally is estimated to be $US 52 billion annually – equivalent to 0.5% of the global health budget.
‘The World Bank told us this is a rounding error [in the context of health spending]. This is not an amount of money which cannot be mobilised,’ Mr Cecchini said.
These sentiments were echoed by the Danish Minister for the Interior and Health Sophie Løhde.
‘To tackle [AMR], we need to work much closer together, and your role as pharmacists and life science professionals is key,’ said Minister Løhde at the first plenary session of the 2025 FIP world congress last week. ‘We need your expertise to develop new antimicrobials in the most prudent and effective manner, and to inform and educate our citizens when you meet them in pharmacies all over the world.’
The FIP Copenhagen Declaration on Antimicrobial Resistance, signed by 79 organisations – including The Pharmaceutical Society of Australia – took place on 1 September 2025.
The FIP Declaration outlines clear priorities to address AMR, including global partnership building, promoting vaccination and rational antimicrobial use, protecting medicine supply chains, and advancing evidence on stewardship and outcomes.
[post_title] => OECD sounds the alarm on antimicrobial resistance
[post_excerpt] => A blistering session at the FIP Congress challenged policymakers and health professionals to slow the advance of antimicrobial resistance.
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[post_content] => A study led by Flinders University and the Southern Adelaide Local Health Network shows that the anti-rheumatic medicine methotrexate significantly reduces blood pressure in some patients compared with sulfasalazine – the first clear evidence of this effect in patients newly diagnosed with rheumatoid arthritis (RA).
The common autoimmune disease occurs in around one in 100 people, leading to inflammation and pain in the connective tissue of the joints.
The inflammation caused by RA contributes to high blood pressure by damaging blood vessels, prompting rheumatologists to realise that people with RA don't typically die because of their condition, said lead researcher Professor Arduino Mangoni, Head of Pharmacology at Flinders University College of Medicine and Public Health.
[caption id="attachment_30469" align="alignright" width="216"] Professor Arduino Mangoni[/caption]
‘The main reason people with RA die is because they have a cardiovascular event, such as a myocardial infarction or stroke,’ he said. ‘And this is often because of an excess prevalence of hypertension in these individuals.’
High blood pressure can significantly shorten the life expectancy of people with RA.
‘An epidemiological study quantifying the burden of cardiovascular disease in people with RA concluded that the increased risk imparted by rheumatoid arthritis was similar to diabetes,’ Prof Mangoni added.
What impact did methotrexate have on blood pressure?
Methotrexate is not the only anti-rheumatic medicine that can reduce hypertension, with hydroxychloroquine also being shown to be potentially protective against atherosclerosis, Prof Mangoni said.
‘So we wanted to use the comparator, sulfasalazine, that was still an anti-inflammatory drug [to test in] people with RA, but with very neutral effects on blood pressure,’ he said.
Among patients with RA, the blood pressure of those taking methotrexate differed by an average of 7.4 mmHg compared with people taking sulfasalazine.
‘Most tablets for blood pressure, when given at a moderate to high dose, will have an effect on blood pressure of between 5–10 mmHg – which is normally, at the population level, associated with the reduction in cardiovascular risk of around 10–15%,’ Prof Mangoni said. ‘So by extrapolation, methotrexate compares very well to a traditional antihypertensive medication.’
In patients with RA who don’t have hypertension, methotrexate could also have a preventative effect.
‘That was very well shown in our study, with only a proportion of [participants] having hypertension,’ Prof Mangoni said.
The medicine can also be assumed to lower cardiovascular risk.
‘If there is a positive effect on blood pressure, consequently, you should have a reduced risk of myocardial infarction and stroke, as well as potentially heart failure,’ he said.
Although the impacts of methotrexate on these indications were not specifically tested in the research, the observational results are promising.
‘They are in line with increasing clinical evidence from epidemiological studies that the use of methotrexate is associated with a reduced risk of heart failure, heart attacks and strokes in people with RA,’ Prof Mangoni said.
Is there potential for a new indication?
In people who have both hypertension and RA, there’s a possibility that medicine regimens could change, Prof Mangoni said.
‘The future should address whether the use of methotrexate in this population can allow modification of antihypertensive medications to have a different treatment regimen,’ he said.
‘Methotrexate could also be an adjuvant, but this can only be tested in adequately designed prospective studies.’
Beyond patients with RA, it’s possible that methotrexate might also be indicated for patients with hypertension in the not-too-distant future. But Prof Mangoni concedes this is an ‘increasingly debated topic’.
‘There has only been one study, published 5 years ago, that looks at the effects of low-dose methotrexate on cardiovascular risk in people without RA,’ he said.
‘The idea was that by giving methotrexate to this population that already has a high pro-inflammatory burden, you would actually reduce the risk of atherosclerosis.’
While this study didn’t yield positive results, there are a few reasons behind this that warrant further exploration. The participants in both the intervention and placebo groups did not have particularly high inflammatory markers, and both groups also received folic acid.
‘Folic acid is given together with methotrexate because it has been shown to reduce the toxicity of [the medicine],’ Prof Mangoni said. ‘However, folic acid can also be protective against atherosclerosis. So the fact that it was also given to the placebo arm might have somewhat diluted the protective effects of methotrexate in this trial.’
To best assess the effects in future research, he suggests a trial design comprising three arms: methotrexate plus folic acid, folic acid alone and the placebo group.
‘I suspect that in the future, methotrexate might have value in people without autoimmune diseases, but with a high inflammatory burden,’ he said.
What role does genetics play in the success of therapy?
Another key finding from the research is that methotrexate may not be the right fit for everyone. The medicine has a complex pharmacology, with several mechanisms facilitating its uptake and storage in cells, Prof Mangoni said.
‘Sometimes it is excreted by the cell, so it [reaches] different targets, with each of these targets potentially having genetic variations,’ he said.
Research has shown that there are several genetic polymorphisms that render people more or less responsive to methotrexate in terms of blood pressure reduction.
‘Interestingly, the polymorphisms that we observed [in our research] are different from the polymorphisms that have been previously described,’ Prof Mangoni said.
‘So future research should look for personalised treatment strategies to identify whether these polymorphisms are similar or different to other polymorphisms responsible for blood pressure reduction – and potentially the reduced risk of atherosclerosis.’
In further research, Prof Mangoni is keen to confirm the role of polymorphisms in lowering blood pressure after treatment with methotrexate, with pharmacogenomics determining who is a suitable candidate for the medicine.
‘The idea is to have a comprehensive genetic panel in people who are considered for treatment for methotrexate to determine from the very beginning who is more or less likely to respond,’ he said.
‘The next step is determining whether these polymorphisms could be translated into a non-RA population to see whether this can be tailored to the treatment of methotrexate in these [people].’
[post_title] => Blood pressure benefits seen with methotrexate treatment
[post_excerpt] => New research links methotrexate to a fall in blood pressure. This expert thinks it could lower cardiovascular risk in the general population.
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[post_content] => Parents have reported persistent anxiety about asthma attacks while children miss out. Pharmacists can help to pivot care from treating flare-ups to stopping them.
Australian families are still living with the hidden emotional toll of childhood asthma – even when they believe control is ‘good enough’.
New research, released as part of the launch of Asthma Australia's new multi-year 'Attack Asthma' campaign found that most (60%) of the parents surveyed live with constant anxiety about the next asthma attack, while 57% worry about their child missing out on normal activities.
A reactive approach to asthma management appears to be driving these concerns, with more than half (58%) of parents revealing their child does not use a preventer daily. More than two-thirds (66%) who notice wheeze, cough or breathlessness dismiss these as symptoms of a lingering cold, virus or allergy, rather than asthma. And even when asthma is suspected, nearly a third (30%) still don’t pursue a diagnosis, assuming the symptoms aren’t severe enough.
This National Asthma Week (1–7 September), Australian Pharmacist sat down with Dr Chris Pearce – a Melbourne-based GP who’s on the board of Asthma Australia – about how pharmacists can help to flip the narrative from ‘asthma attack’ to ‘attack asthma’.
Shifting the perspective from reactive to proactive
The difference between asthma and many other chronic conditions is its variability.
So for many decades, asthma care typically began with a reliever (usually a short-acting beta-2 agonist (SABA) as the first step for symptom relief.
‘The asthma action plans in times past emphasised that if you get an [attack] use [salbutamol] Ventolin,’ Dr Pearce said. ‘But we've now moved on to encourage the increased use of preventers to stop the acute attacks.’
The purpose of this strategy is to lessen the impact of asthma on children, along with the parental anxiety that goes with it.
‘The classic example is sport where we used to say, “make sure you've got a blue puffer and use it if you get a bit wheezy”,’ he said.
Even without obvious symptoms such as coughing and shortness of breath, these children were likely experiencing mild symptoms such as tiredness, Dr Pearce said.
‘They weren't reaching their full potential because they had subclinical symptoms,’ he said.
When dispensing preventers and supplying salbutamol, pharmacists can help to transform the approach to asthma management from reactive to proactive.
‘What you do in the intervals between attacks, that’s more important than how you manage an actual attack,’ Dr Pearce said.
‘I say to people, “This is a disease that you have all the time, and we need to manage it all the time because we're trying to maximise your child's potential, rather than just treating attacks.”
Identifying undiagnosed or uncontrolled asthma
Pharmacists are often the first port of call when children experience a minor ailment, Dr Pearce said.
‘That’s when parents front up to the pharmacy and say, “my child has a cough” or “my child's a bit wheezy”,’ he said.
But if you dig a little deeper, you can often unearth the root cause.
‘If you ask a few questions rather than taking it at face value, it might be revealed that they haven't got a runny nose or a temperature, and it could actually be a manifestation of asthma,’ he said.
‘If a child tends to get a cough with every cold and they're coming in for the cough syrup each and every time, that's a bit of a red flag.’
When parents of children who do have confirmed asthma buy salbutamol over-the-counter, pharmacists should monitor how often they purchase it and recommend a formal assessment where appropriate.
‘It’s not about refusing people who want to buy Ventolin, but just planting the seed that a more formal assessment is a good thing,’ Dr Pearce said.
Another indicator can lie in My Health Record.
‘You might see that, unbeknownst to you, there's been a couple of scripts of oral prednisolone from the local hospital,’ he said.
Picking up on poor inhaler technique
Even when patients are using preventer medicines, the wrong inhaler technique can impact treatment outcomes.
This can include anything from not using a spacer when it’s deemed appropriate or not pointing the inhaler in the right direction.
‘I've seen inhalers held six inches away from the mouth,’ Dr Pearce said. ‘I've also seen people who use other devices such as Turbuhalers not click the dial, so they're just inhaling air,’ he said.
When a preventer is first prescribed, Dr Pearce advises pharmacists to demonstrate the correct technique.
‘Then there's a role, especially in children, to check their technique a couple of times a year,’ he said. ‘You can also get the parent to bring the spacer in to check if it’s cracked and broken.’
In children with mild and intermittent asthma, pharmacists can also check whether the preventer dose is appropriate.
‘They grow, but [sometimes] their dose doesn't,’ he said. ‘So you need to occasionally rethink whether they're getting the right dose, and suggest they should go to the GP to get it reviewed.’
Improving adherence and long-term management
Pharmacists can help to reinforce strategies to improve adherence, Dr Pearce said.
‘One of the things about regular maintenance is that it's regular, so it gets into the routine,’ he said. ‘So if you're going to use an inhaler and spacer in the morning and night, having it when you get up and when you go to bed is easier to remember than having to pack it in your school bag every day,’ he said.
Asthma patterns are individual and can vary seasonally. So in all asthma cases, reviewing the pattern of disease is key.
‘For some people, spring has no impact, whereas for others it’s a complete disaster,’ Dr Pearce said.
‘For those patients, my recommendation would be to double the preventer dose for the next couple of months so they continue to be well – regardless of what's going on with the weather.
‘We're keen on a review every 6 months, even in stable children, just to make sure that everyone's keeping on top of it.’
For parents who are concerned about the medication burden of daily preventer use, Dr Pearce said it’s important to emphasise the risks and benefits.
‘There are some side effects from taking inhaled corticosteroids on a regular basis, but they're unusual, and if they do occur they are mild – much less than what you would get from several courses of oral corticosteroids over a year when asthma is not controlled,’ he said.
It’s also important for parents to balance the potential adverse effects from long-term corticosteroid use in a child with mild and untreated asthma, who's not able to concentrate at school.
‘If they’re not able to concentrate at school or perform at their best in sport, in my view the benefits outweigh the risks,’ Dr Pearce said.
It’s also helpful to remind parents that the better controlled their child’s asthma is, the lower their dose of inhaled corticosteroids will need to be.
‘The old asthma action plans used to say, “use your Ventolin when you need it. And if you get sick, take a big dose of your inhaled corticosteroids”,’ Dr Pearce said. ‘But if we use a small dose regularly, it’s much better tolerated by the body.’
[post_title] => The hidden toll of ‘good enough’ asthma control
[post_excerpt] => Parents have reported persistent anxiety about asthma attacks. Pharmacists can help to pivot care from treating flare-ups to stopping them.
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[post_content] => Women of reproductive age using glucagon-like peptide-1 receptor agonists (GLP-1 RAs) could be at risk of unintended pregnancy, and may be unaware of associated risks to pregnancy and unborn babies.
A new study by Flinders University, which examined records from more than 1.6 million women aged 18–49 who attended general practice between 2011 and 2022, found that only one in five (21%) of those with first prescribing of GLP-1 RAs had documented contraceptive use.
The study also found that most prescriptions for GLP-1 RAs are now issued to women without diabetes. In 2022 alone, more than 6,000 women began treatment on GLP-1 RAs, and over 90% of those did not have a type 2 diabetes diagnosis.
[caption id="attachment_30483" align="alignright" width="300"] Associate Professor Luke Grzeskowiak[/caption]
Participants were tracked at the initial stages of GLP-1 RA therapy, with the research team looking at documented evidence of pregnancies over a 6-month period, said lead author and pharmacist, Associate Professor Luke Grzeskowiak.
‘[While] limited to data from GP records, one in 25 women aged 18 to 34 years had a documented pregnancy at the time of prescribing,’ he said.
‘There will also be pregnancies that the GP might not be aware of, so if anything, what we're expecting is that this is an underestimate of what's truly happening.’
Those who were prescribed concurrent contraception were 50% less likely to have a documented pregnancy.
‘So we've got clear evidence that contraceptive use at the time of initiating these medicines reduces the risk of pregnancies occurring,’ A/Prof Grzeskowiak said.
Why does GLP-1 RA use increase pregnancy risk?
There are two key reasons: first, it is ‘well established’ that weight loss can improve fertility.
‘Because we know these medicines are very effective at promoting weight loss, it's highly plausible that they could improve fertility through that mechanism,’ A/Prof Grzeskowiak said.
There have also been concerns that GLP-1 RAs might impact absorption of the oral contraceptive pill.
In June 2025, the UK’s Medicines and Healthcare products Regulatory Agency issued a regulatory warning following case reports of unexpected pregnancies associated with GLP-1 RA use.
‘A detailed review [revealed] that the strongest evidence was around potential interaction between tirzepatide and reduced effectiveness of oral contraception,’ A/Prof Grzeskowiak said.
To date, evidence regarding interactions between GLP-1 RAs and the oral contraceptive pill is limited.
‘So the general recommendations around that regulatory warning were for those relying on oral contraceptive methods to also consider using a barrier method,’ he said.
What are the congenital risk factors?
The research also considered potential harms associated with GLP-1 RAs in pregnancy. Key concerns were taken from a University of Amsterdam review of animal studies, cited in the Flinders University study.
‘In animals, use of GLP-1 RAs [in pregnancy] led to reductions in foetal growth, impairments in bone development and impaired maternal weight gain,’ A/Prof Grzeskowiak said.
At this stage, the human data are more reassuring.
‘The studies that have been done have not shown an increased risk of birth defects,’ he said. ‘But they are still relatively limited in terms of numbers, and we don't have an examination of the full range of pregnancy outcomes yet,’ he said.
Due to this uncertainty, an abundance of caution is advised.
‘The recommendations are to not use these medicines during pregnancy, and to avoid the potential for them to be used during pregnancy accidentally,’ A/Prof Grzeskowiak said. ‘So it’s important to have a plan around concurrent contraception use, high-quality pre-conception care, and ensure that where pregnancies are planned, everything has been done to optimise pregnancy outcomes.’
What should pharmacists advise patients?
Dispensing GLP-1 RAs provides important opportunities for pharmacists to talk to patients about reproductive health.
For example, when dispensing tirzepatide, access to dispensing data on contraceptive methods enables pharmacists to raise awareness of the potential interaction by initiating an open and unassuming conversation, A/Prof Grzeskowiak said.
‘Having a conversation about how that might be addressed means patients can make an informed decision,’ he said. ‘It might mean changing contraceptive methods or [referring] them back to the GP for a conversation. Or it may be that they're using contraceptives for non-contraceptive purposes such as acne [management], so there’s a low risk of pregnancy.’
The initiation of therapy is the ideal time to discuss potential risks.
‘That way people know what to expect in terms of the medicines,’ he said.
When commencing GLP-1 RAs, patients may also experience profound gastrointestinal adverse effects, including vomiting or diarrhoea.
‘That in itself can reduce the effectiveness of oral contraception, regardless of any other interactions,’ A/Prof Grzeskowiak said. ‘So people should be aware of the side effects of what to expect when starting this and how it might impact on other treatments that they're using.’
Pharmacists have an important role in engaging patients in conversations about reproductive health, particularly contraception.
‘Not everyone feels comfortable asking those questions, but there are good training resources, particularly through PSA, around improving pharmacists’ comfort with having those conversations, including around the different types of contraceptive methods,’ he said.
‘It's one thing to start the conversation, but you also need to be armed with various information to be able to continue it, or at least identify when to refer patients back to their medical practitioner or another [healthcare practitioner] to provide that detailed advice.’
[post_title] => GLP-1 RAs found to pose pregnancy risks
[post_excerpt] => Women of reproductive age using GLP-1 RAs could be at risk of unintended pregnancy, and unaware of the risks to pregnancy and unborn babies.
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[post_content] => In August 2025, I had the privilege of attending the International Pharmaceutical Students’ Federation (IPSF) World Congress in Nairobi, Kenya.
The theme of this year’s congress, Advancing Pharmacy Education and Practice for Global Health Impact, was reflected throughout the week in discussions, panels and workshops.
Thanks to the generous support of PSA and the National Australian Pharmacy Students’ Association (NAPSA), I was able to represent both Australia and New Zealand as the sole Official Delegate at the General Assembly. Without their support, our countries would not have had a voice.
Leaders in training
Before the official start of World Congress, I participated in the Leaders in Training (LiT) program, where I became an Alpha Trainer after reaching the required hours. I ran workshops focused on developing soft skills for future leaders, guiding students through sessions on motivation, feedback and evaluation.
This was a rewarding opportunity to share knowledge, strengthen my own skills, and witness the energy and passion of upcoming leaders.
Once the Congress began, much of my time was spent in the General Assembly, carrying the responsibility of casting votes and ensuring the perspectives of
students from both Australia and New Zealand were heard. Being the only delegate from our area made me realise just how vital the support of PSA and NAPSA was.
Technology and access
Among the many events I attended, one highlight was a panel discussion on the use of AI in healthcare. This session offered a fascinating look at both the opportunities and the challenges of integrating AI into healthcare delivery.
I also gained insight into the industrial pharmacy sector in Kenya, as well as the broader challenges faced by healthcare in Nairobi. These experiences expanded my understanding of the global landscape of pharmacy and reminded me of the inequities that continue to exist in access to medicines and resources.
The Congress also gave me the chance to reconnect with peers from around the world, including those I had previously worked with as NAPSA’s Contact Person. It was valuable to strengthen existing connections and build friendships with students who share the same interest in pharmacy.World Congress was a once-in-a-lifetime experience; one I hope more Australian pharmacy students will pursue in the future.
Start local, go global
IPSF represents over 500,000 pharmacy students worldwide, yet Australia’s presence remains small. I want to change that by encouraging more students to get involved and take advantage of the opportunities IPSF offers.
The first step is to become involved in your local student branch, which can then open doors to national opportunities through NAPSA and, eventually, to international representation.
I still remember attending my first IPSF conference alone and feeling nervous, only to be welcomed immediately by the IPSF Asia Pacific Regional Office (APRO), who embraced me as part of their community. The warmth and inclusivity I experienced then continues to inspire me, and I encourage others to take the same leap.
People want to connect with you, and IPSF provides a space where friendships, networks, and professional growth come naturally.
Looking ahead, the next IPSF events will be the Asia Pacific Pharmaceutical Symposium (APPS) in Indonesia and the World Congress in Thailand. I would strongly encourage pharmacy students to consider attending these future events, as they are transformative experiences that broaden horizons, deepen understanding and build lifelong networks.
Pathways Ahead
I am deeply grateful to PSA for their monumental support in making my attendance possible. With travel costs being high, it would have been impossible for me to attend without their sponsorship.
Because of their generosity, Australia and New Zealand were represented at the General Assembly, and our perspectives contributed to global discussions.
I also want to thank NAPSA for their support, which made it more feasible for me to attend in my role as Official Delegate. Their backing ensured that I was able to fulfil my duties and give our members a voice on the international stage.
Attending World Congress 2025 in Nairobi was an unforgettable experience that strengthened my leadership skills, broadened my understanding of global healthcare, and connected me with pharmacy students from across the world.
Most importantly, it reminded me of the importance of ensuring Australia and New Zealand are active participants in shaping the future of our profession.
To PSA and NAPSA, thank you once again for making this possible. To my fellow pharmacy students, I encourage you to take that first step, get involved, and see where it leads. You might just find yourself representing our country on the world stage one day.
[post_title] => A voice for Australia and New Zealand at IPSF 2025
[post_excerpt] => Australia and New Zealand had a voice at the IPSF World Congress, influencing discussions on education, practice and global health.
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[title] => A voice for Australia and New Zealand at IPSF 2025
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[post_content] => A blistering opening plenary session at the FIP Congress last week has challenged policymakers and health professionals alike to act to slow the advance of antimicrobial resistance (AMR).
Mr Michele Cecchini, Head of Public Health, Organisation for Economic Co-operation and Development (OECD), worked through startling data showing the cost of AMR globally – in dollars, and in years of life lost.
The high price of insufficient action on AMR
The OECD has crunched the numbers, and the statistics are startling.
AMR is currently shortening life expectancy by an average of 1.8 years globally – 1.7 years for people in high-income countries, or 2.5 years for people in low-income countries.
This is represented in 79,000 people dying due to resistant infections across 34 OECD, European Union and European Economic Area counties – corresponding to 2.4 times the number of deaths due to tuberculosis, influenza and HIV/AIDS combined in 2020.
The financial burden on the health system is similarly staggering, with global annual costs totalling $US 412 billion.
Once lost productivity and loss of income costs are added in, this cost balloons to $US 850 billion annually – about the same size of Poland’s economy.
Bold action is required
Modelling by the OECD has shown that meaningful action is achievable – albeit with a substantial price tag.
To reduce AMR-related deaths by 10%, six actions are required:
- All countries need to have national AMR action plans and 60% of countries commit a budget
- 90% of countries should meet WHO’s minimum infection prevention and control programs at a national level
- All countries need to report surveillance data on AMR and antimicrobial use
- Meaningful reduction in antimicrobial use is taken in agrifood systems
- Strengthened actions to prevent and address the discharge of antimicrobials into the environment
- Mechanisms to support research and development to address AMR should be promoted.
The cost of these initiatives globally is estimated to be $US 52 billion annually – equivalent to 0.5% of the global health budget.
‘The World Bank told us this is a rounding error [in the context of health spending]. This is not an amount of money which cannot be mobilised,’ Mr Cecchini said.
These sentiments were echoed by the Danish Minister for the Interior and Health Sophie Løhde.
‘To tackle [AMR], we need to work much closer together, and your role as pharmacists and life science professionals is key,’ said Minister Løhde at the first plenary session of the 2025 FIP world congress last week. ‘We need your expertise to develop new antimicrobials in the most prudent and effective manner, and to inform and educate our citizens when you meet them in pharmacies all over the world.’
The FIP Copenhagen Declaration on Antimicrobial Resistance, signed by 79 organisations – including The Pharmaceutical Society of Australia – took place on 1 September 2025.
The FIP Declaration outlines clear priorities to address AMR, including global partnership building, promoting vaccination and rational antimicrobial use, protecting medicine supply chains, and advancing evidence on stewardship and outcomes.
[post_title] => OECD sounds the alarm on antimicrobial resistance
[post_excerpt] => A blistering session at the FIP Congress challenged policymakers and health professionals to slow the advance of antimicrobial resistance.
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[post_content] => A study led by Flinders University and the Southern Adelaide Local Health Network shows that the anti-rheumatic medicine methotrexate significantly reduces blood pressure in some patients compared with sulfasalazine – the first clear evidence of this effect in patients newly diagnosed with rheumatoid arthritis (RA).
The common autoimmune disease occurs in around one in 100 people, leading to inflammation and pain in the connective tissue of the joints.
The inflammation caused by RA contributes to high blood pressure by damaging blood vessels, prompting rheumatologists to realise that people with RA don't typically die because of their condition, said lead researcher Professor Arduino Mangoni, Head of Pharmacology at Flinders University College of Medicine and Public Health.
[caption id="attachment_30469" align="alignright" width="216"] Professor Arduino Mangoni[/caption]
‘The main reason people with RA die is because they have a cardiovascular event, such as a myocardial infarction or stroke,’ he said. ‘And this is often because of an excess prevalence of hypertension in these individuals.’
High blood pressure can significantly shorten the life expectancy of people with RA.
‘An epidemiological study quantifying the burden of cardiovascular disease in people with RA concluded that the increased risk imparted by rheumatoid arthritis was similar to diabetes,’ Prof Mangoni added.
What impact did methotrexate have on blood pressure?
Methotrexate is not the only anti-rheumatic medicine that can reduce hypertension, with hydroxychloroquine also being shown to be potentially protective against atherosclerosis, Prof Mangoni said.
‘So we wanted to use the comparator, sulfasalazine, that was still an anti-inflammatory drug [to test in] people with RA, but with very neutral effects on blood pressure,’ he said.
Among patients with RA, the blood pressure of those taking methotrexate differed by an average of 7.4 mmHg compared with people taking sulfasalazine.
‘Most tablets for blood pressure, when given at a moderate to high dose, will have an effect on blood pressure of between 5–10 mmHg – which is normally, at the population level, associated with the reduction in cardiovascular risk of around 10–15%,’ Prof Mangoni said. ‘So by extrapolation, methotrexate compares very well to a traditional antihypertensive medication.’
In patients with RA who don’t have hypertension, methotrexate could also have a preventative effect.
‘That was very well shown in our study, with only a proportion of [participants] having hypertension,’ Prof Mangoni said.
The medicine can also be assumed to lower cardiovascular risk.
‘If there is a positive effect on blood pressure, consequently, you should have a reduced risk of myocardial infarction and stroke, as well as potentially heart failure,’ he said.
Although the impacts of methotrexate on these indications were not specifically tested in the research, the observational results are promising.
‘They are in line with increasing clinical evidence from epidemiological studies that the use of methotrexate is associated with a reduced risk of heart failure, heart attacks and strokes in people with RA,’ Prof Mangoni said.
Is there potential for a new indication?
In people who have both hypertension and RA, there’s a possibility that medicine regimens could change, Prof Mangoni said.
‘The future should address whether the use of methotrexate in this population can allow modification of antihypertensive medications to have a different treatment regimen,’ he said.
‘Methotrexate could also be an adjuvant, but this can only be tested in adequately designed prospective studies.’
Beyond patients with RA, it’s possible that methotrexate might also be indicated for patients with hypertension in the not-too-distant future. But Prof Mangoni concedes this is an ‘increasingly debated topic’.
‘There has only been one study, published 5 years ago, that looks at the effects of low-dose methotrexate on cardiovascular risk in people without RA,’ he said.
‘The idea was that by giving methotrexate to this population that already has a high pro-inflammatory burden, you would actually reduce the risk of atherosclerosis.’
While this study didn’t yield positive results, there are a few reasons behind this that warrant further exploration. The participants in both the intervention and placebo groups did not have particularly high inflammatory markers, and both groups also received folic acid.
‘Folic acid is given together with methotrexate because it has been shown to reduce the toxicity of [the medicine],’ Prof Mangoni said. ‘However, folic acid can also be protective against atherosclerosis. So the fact that it was also given to the placebo arm might have somewhat diluted the protective effects of methotrexate in this trial.’
To best assess the effects in future research, he suggests a trial design comprising three arms: methotrexate plus folic acid, folic acid alone and the placebo group.
‘I suspect that in the future, methotrexate might have value in people without autoimmune diseases, but with a high inflammatory burden,’ he said.
What role does genetics play in the success of therapy?
Another key finding from the research is that methotrexate may not be the right fit for everyone. The medicine has a complex pharmacology, with several mechanisms facilitating its uptake and storage in cells, Prof Mangoni said.
‘Sometimes it is excreted by the cell, so it [reaches] different targets, with each of these targets potentially having genetic variations,’ he said.
Research has shown that there are several genetic polymorphisms that render people more or less responsive to methotrexate in terms of blood pressure reduction.
‘Interestingly, the polymorphisms that we observed [in our research] are different from the polymorphisms that have been previously described,’ Prof Mangoni said.
‘So future research should look for personalised treatment strategies to identify whether these polymorphisms are similar or different to other polymorphisms responsible for blood pressure reduction – and potentially the reduced risk of atherosclerosis.’
In further research, Prof Mangoni is keen to confirm the role of polymorphisms in lowering blood pressure after treatment with methotrexate, with pharmacogenomics determining who is a suitable candidate for the medicine.
‘The idea is to have a comprehensive genetic panel in people who are considered for treatment for methotrexate to determine from the very beginning who is more or less likely to respond,’ he said.
‘The next step is determining whether these polymorphisms could be translated into a non-RA population to see whether this can be tailored to the treatment of methotrexate in these [people].’
[post_title] => Blood pressure benefits seen with methotrexate treatment
[post_excerpt] => New research links methotrexate to a fall in blood pressure. This expert thinks it could lower cardiovascular risk in the general population.
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[post_content] => Parents have reported persistent anxiety about asthma attacks while children miss out. Pharmacists can help to pivot care from treating flare-ups to stopping them.
Australian families are still living with the hidden emotional toll of childhood asthma – even when they believe control is ‘good enough’.
New research, released as part of the launch of Asthma Australia's new multi-year 'Attack Asthma' campaign found that most (60%) of the parents surveyed live with constant anxiety about the next asthma attack, while 57% worry about their child missing out on normal activities.
A reactive approach to asthma management appears to be driving these concerns, with more than half (58%) of parents revealing their child does not use a preventer daily. More than two-thirds (66%) who notice wheeze, cough or breathlessness dismiss these as symptoms of a lingering cold, virus or allergy, rather than asthma. And even when asthma is suspected, nearly a third (30%) still don’t pursue a diagnosis, assuming the symptoms aren’t severe enough.
This National Asthma Week (1–7 September), Australian Pharmacist sat down with Dr Chris Pearce – a Melbourne-based GP who’s on the board of Asthma Australia – about how pharmacists can help to flip the narrative from ‘asthma attack’ to ‘attack asthma’.
Shifting the perspective from reactive to proactive
The difference between asthma and many other chronic conditions is its variability.
So for many decades, asthma care typically began with a reliever (usually a short-acting beta-2 agonist (SABA) as the first step for symptom relief.
‘The asthma action plans in times past emphasised that if you get an [attack] use [salbutamol] Ventolin,’ Dr Pearce said. ‘But we've now moved on to encourage the increased use of preventers to stop the acute attacks.’
The purpose of this strategy is to lessen the impact of asthma on children, along with the parental anxiety that goes with it.
‘The classic example is sport where we used to say, “make sure you've got a blue puffer and use it if you get a bit wheezy”,’ he said.
Even without obvious symptoms such as coughing and shortness of breath, these children were likely experiencing mild symptoms such as tiredness, Dr Pearce said.
‘They weren't reaching their full potential because they had subclinical symptoms,’ he said.
When dispensing preventers and supplying salbutamol, pharmacists can help to transform the approach to asthma management from reactive to proactive.
‘What you do in the intervals between attacks, that’s more important than how you manage an actual attack,’ Dr Pearce said.
‘I say to people, “This is a disease that you have all the time, and we need to manage it all the time because we're trying to maximise your child's potential, rather than just treating attacks.”
Identifying undiagnosed or uncontrolled asthma
Pharmacists are often the first port of call when children experience a minor ailment, Dr Pearce said.
‘That’s when parents front up to the pharmacy and say, “my child has a cough” or “my child's a bit wheezy”,’ he said.
But if you dig a little deeper, you can often unearth the root cause.
‘If you ask a few questions rather than taking it at face value, it might be revealed that they haven't got a runny nose or a temperature, and it could actually be a manifestation of asthma,’ he said.
‘If a child tends to get a cough with every cold and they're coming in for the cough syrup each and every time, that's a bit of a red flag.’
When parents of children who do have confirmed asthma buy salbutamol over-the-counter, pharmacists should monitor how often they purchase it and recommend a formal assessment where appropriate.
‘It’s not about refusing people who want to buy Ventolin, but just planting the seed that a more formal assessment is a good thing,’ Dr Pearce said.
Another indicator can lie in My Health Record.
‘You might see that, unbeknownst to you, there's been a couple of scripts of oral prednisolone from the local hospital,’ he said.
Picking up on poor inhaler technique
Even when patients are using preventer medicines, the wrong inhaler technique can impact treatment outcomes.
This can include anything from not using a spacer when it’s deemed appropriate or not pointing the inhaler in the right direction.
‘I've seen inhalers held six inches away from the mouth,’ Dr Pearce said. ‘I've also seen people who use other devices such as Turbuhalers not click the dial, so they're just inhaling air,’ he said.
When a preventer is first prescribed, Dr Pearce advises pharmacists to demonstrate the correct technique.
‘Then there's a role, especially in children, to check their technique a couple of times a year,’ he said. ‘You can also get the parent to bring the spacer in to check if it’s cracked and broken.’
In children with mild and intermittent asthma, pharmacists can also check whether the preventer dose is appropriate.
‘They grow, but [sometimes] their dose doesn't,’ he said. ‘So you need to occasionally rethink whether they're getting the right dose, and suggest they should go to the GP to get it reviewed.’
Improving adherence and long-term management
Pharmacists can help to reinforce strategies to improve adherence, Dr Pearce said.
‘One of the things about regular maintenance is that it's regular, so it gets into the routine,’ he said. ‘So if you're going to use an inhaler and spacer in the morning and night, having it when you get up and when you go to bed is easier to remember than having to pack it in your school bag every day,’ he said.
Asthma patterns are individual and can vary seasonally. So in all asthma cases, reviewing the pattern of disease is key.
‘For some people, spring has no impact, whereas for others it’s a complete disaster,’ Dr Pearce said.
‘For those patients, my recommendation would be to double the preventer dose for the next couple of months so they continue to be well – regardless of what's going on with the weather.
‘We're keen on a review every 6 months, even in stable children, just to make sure that everyone's keeping on top of it.’
For parents who are concerned about the medication burden of daily preventer use, Dr Pearce said it’s important to emphasise the risks and benefits.
‘There are some side effects from taking inhaled corticosteroids on a regular basis, but they're unusual, and if they do occur they are mild – much less than what you would get from several courses of oral corticosteroids over a year when asthma is not controlled,’ he said.
It’s also important for parents to balance the potential adverse effects from long-term corticosteroid use in a child with mild and untreated asthma, who's not able to concentrate at school.
‘If they’re not able to concentrate at school or perform at their best in sport, in my view the benefits outweigh the risks,’ Dr Pearce said.
It’s also helpful to remind parents that the better controlled their child’s asthma is, the lower their dose of inhaled corticosteroids will need to be.
‘The old asthma action plans used to say, “use your Ventolin when you need it. And if you get sick, take a big dose of your inhaled corticosteroids”,’ Dr Pearce said. ‘But if we use a small dose regularly, it’s much better tolerated by the body.’
[post_title] => The hidden toll of ‘good enough’ asthma control
[post_excerpt] => Parents have reported persistent anxiety about asthma attacks. Pharmacists can help to pivot care from treating flare-ups to stopping them.
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[post_content] => Women of reproductive age using glucagon-like peptide-1 receptor agonists (GLP-1 RAs) could be at risk of unintended pregnancy, and may be unaware of associated risks to pregnancy and unborn babies.
A new study by Flinders University, which examined records from more than 1.6 million women aged 18–49 who attended general practice between 2011 and 2022, found that only one in five (21%) of those with first prescribing of GLP-1 RAs had documented contraceptive use.
The study also found that most prescriptions for GLP-1 RAs are now issued to women without diabetes. In 2022 alone, more than 6,000 women began treatment on GLP-1 RAs, and over 90% of those did not have a type 2 diabetes diagnosis.
[caption id="attachment_30483" align="alignright" width="300"] Associate Professor Luke Grzeskowiak[/caption]
Participants were tracked at the initial stages of GLP-1 RA therapy, with the research team looking at documented evidence of pregnancies over a 6-month period, said lead author and pharmacist, Associate Professor Luke Grzeskowiak.
‘[While] limited to data from GP records, one in 25 women aged 18 to 34 years had a documented pregnancy at the time of prescribing,’ he said.
‘There will also be pregnancies that the GP might not be aware of, so if anything, what we're expecting is that this is an underestimate of what's truly happening.’
Those who were prescribed concurrent contraception were 50% less likely to have a documented pregnancy.
‘So we've got clear evidence that contraceptive use at the time of initiating these medicines reduces the risk of pregnancies occurring,’ A/Prof Grzeskowiak said.
Why does GLP-1 RA use increase pregnancy risk?
There are two key reasons: first, it is ‘well established’ that weight loss can improve fertility.
‘Because we know these medicines are very effective at promoting weight loss, it's highly plausible that they could improve fertility through that mechanism,’ A/Prof Grzeskowiak said.
There have also been concerns that GLP-1 RAs might impact absorption of the oral contraceptive pill.
In June 2025, the UK’s Medicines and Healthcare products Regulatory Agency issued a regulatory warning following case reports of unexpected pregnancies associated with GLP-1 RA use.
‘A detailed review [revealed] that the strongest evidence was around potential interaction between tirzepatide and reduced effectiveness of oral contraception,’ A/Prof Grzeskowiak said.
To date, evidence regarding interactions between GLP-1 RAs and the oral contraceptive pill is limited.
‘So the general recommendations around that regulatory warning were for those relying on oral contraceptive methods to also consider using a barrier method,’ he said.
What are the congenital risk factors?
The research also considered potential harms associated with GLP-1 RAs in pregnancy. Key concerns were taken from a University of Amsterdam review of animal studies, cited in the Flinders University study.
‘In animals, use of GLP-1 RAs [in pregnancy] led to reductions in foetal growth, impairments in bone development and impaired maternal weight gain,’ A/Prof Grzeskowiak said.
At this stage, the human data are more reassuring.
‘The studies that have been done have not shown an increased risk of birth defects,’ he said. ‘But they are still relatively limited in terms of numbers, and we don't have an examination of the full range of pregnancy outcomes yet,’ he said.
Due to this uncertainty, an abundance of caution is advised.
‘The recommendations are to not use these medicines during pregnancy, and to avoid the potential for them to be used during pregnancy accidentally,’ A/Prof Grzeskowiak said. ‘So it’s important to have a plan around concurrent contraception use, high-quality pre-conception care, and ensure that where pregnancies are planned, everything has been done to optimise pregnancy outcomes.’
What should pharmacists advise patients?
Dispensing GLP-1 RAs provides important opportunities for pharmacists to talk to patients about reproductive health.
For example, when dispensing tirzepatide, access to dispensing data on contraceptive methods enables pharmacists to raise awareness of the potential interaction by initiating an open and unassuming conversation, A/Prof Grzeskowiak said.
‘Having a conversation about how that might be addressed means patients can make an informed decision,’ he said. ‘It might mean changing contraceptive methods or [referring] them back to the GP for a conversation. Or it may be that they're using contraceptives for non-contraceptive purposes such as acne [management], so there’s a low risk of pregnancy.’
The initiation of therapy is the ideal time to discuss potential risks.
‘That way people know what to expect in terms of the medicines,’ he said.
When commencing GLP-1 RAs, patients may also experience profound gastrointestinal adverse effects, including vomiting or diarrhoea.
‘That in itself can reduce the effectiveness of oral contraception, regardless of any other interactions,’ A/Prof Grzeskowiak said. ‘So people should be aware of the side effects of what to expect when starting this and how it might impact on other treatments that they're using.’
Pharmacists have an important role in engaging patients in conversations about reproductive health, particularly contraception.
‘Not everyone feels comfortable asking those questions, but there are good training resources, particularly through PSA, around improving pharmacists’ comfort with having those conversations, including around the different types of contraceptive methods,’ he said.
‘It's one thing to start the conversation, but you also need to be armed with various information to be able to continue it, or at least identify when to refer patients back to their medical practitioner or another [healthcare practitioner] to provide that detailed advice.’
[post_title] => GLP-1 RAs found to pose pregnancy risks
[post_excerpt] => Women of reproductive age using GLP-1 RAs could be at risk of unintended pregnancy, and unaware of the risks to pregnancy and unborn babies.
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[post_content] => In August 2025, I had the privilege of attending the International Pharmaceutical Students’ Federation (IPSF) World Congress in Nairobi, Kenya.
The theme of this year’s congress, Advancing Pharmacy Education and Practice for Global Health Impact, was reflected throughout the week in discussions, panels and workshops.
Thanks to the generous support of PSA and the National Australian Pharmacy Students’ Association (NAPSA), I was able to represent both Australia and New Zealand as the sole Official Delegate at the General Assembly. Without their support, our countries would not have had a voice.
Leaders in training
Before the official start of World Congress, I participated in the Leaders in Training (LiT) program, where I became an Alpha Trainer after reaching the required hours. I ran workshops focused on developing soft skills for future leaders, guiding students through sessions on motivation, feedback and evaluation.
This was a rewarding opportunity to share knowledge, strengthen my own skills, and witness the energy and passion of upcoming leaders.
Once the Congress began, much of my time was spent in the General Assembly, carrying the responsibility of casting votes and ensuring the perspectives of
students from both Australia and New Zealand were heard. Being the only delegate from our area made me realise just how vital the support of PSA and NAPSA was.
Technology and access
Among the many events I attended, one highlight was a panel discussion on the use of AI in healthcare. This session offered a fascinating look at both the opportunities and the challenges of integrating AI into healthcare delivery.
I also gained insight into the industrial pharmacy sector in Kenya, as well as the broader challenges faced by healthcare in Nairobi. These experiences expanded my understanding of the global landscape of pharmacy and reminded me of the inequities that continue to exist in access to medicines and resources.
The Congress also gave me the chance to reconnect with peers from around the world, including those I had previously worked with as NAPSA’s Contact Person. It was valuable to strengthen existing connections and build friendships with students who share the same interest in pharmacy.World Congress was a once-in-a-lifetime experience; one I hope more Australian pharmacy students will pursue in the future.
Start local, go global
IPSF represents over 500,000 pharmacy students worldwide, yet Australia’s presence remains small. I want to change that by encouraging more students to get involved and take advantage of the opportunities IPSF offers.
The first step is to become involved in your local student branch, which can then open doors to national opportunities through NAPSA and, eventually, to international representation.
I still remember attending my first IPSF conference alone and feeling nervous, only to be welcomed immediately by the IPSF Asia Pacific Regional Office (APRO), who embraced me as part of their community. The warmth and inclusivity I experienced then continues to inspire me, and I encourage others to take the same leap.
People want to connect with you, and IPSF provides a space where friendships, networks, and professional growth come naturally.
Looking ahead, the next IPSF events will be the Asia Pacific Pharmaceutical Symposium (APPS) in Indonesia and the World Congress in Thailand. I would strongly encourage pharmacy students to consider attending these future events, as they are transformative experiences that broaden horizons, deepen understanding and build lifelong networks.
Pathways Ahead
I am deeply grateful to PSA for their monumental support in making my attendance possible. With travel costs being high, it would have been impossible for me to attend without their sponsorship.
Because of their generosity, Australia and New Zealand were represented at the General Assembly, and our perspectives contributed to global discussions.
I also want to thank NAPSA for their support, which made it more feasible for me to attend in my role as Official Delegate. Their backing ensured that I was able to fulfil my duties and give our members a voice on the international stage.
Attending World Congress 2025 in Nairobi was an unforgettable experience that strengthened my leadership skills, broadened my understanding of global healthcare, and connected me with pharmacy students from across the world.
Most importantly, it reminded me of the importance of ensuring Australia and New Zealand are active participants in shaping the future of our profession.
To PSA and NAPSA, thank you once again for making this possible. To my fellow pharmacy students, I encourage you to take that first step, get involved, and see where it leads. You might just find yourself representing our country on the world stage one day.
[post_title] => A voice for Australia and New Zealand at IPSF 2025
[post_excerpt] => Australia and New Zealand had a voice at the IPSF World Congress, influencing discussions on education, practice and global health.
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[title] => A voice for Australia and New Zealand at IPSF 2025
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[post_content] => A blistering opening plenary session at the FIP Congress last week has challenged policymakers and health professionals alike to act to slow the advance of antimicrobial resistance (AMR).
Mr Michele Cecchini, Head of Public Health, Organisation for Economic Co-operation and Development (OECD), worked through startling data showing the cost of AMR globally – in dollars, and in years of life lost.
The high price of insufficient action on AMR
The OECD has crunched the numbers, and the statistics are startling.
AMR is currently shortening life expectancy by an average of 1.8 years globally – 1.7 years for people in high-income countries, or 2.5 years for people in low-income countries.
This is represented in 79,000 people dying due to resistant infections across 34 OECD, European Union and European Economic Area counties – corresponding to 2.4 times the number of deaths due to tuberculosis, influenza and HIV/AIDS combined in 2020.
The financial burden on the health system is similarly staggering, with global annual costs totalling $US 412 billion.
Once lost productivity and loss of income costs are added in, this cost balloons to $US 850 billion annually – about the same size of Poland’s economy.
Bold action is required
Modelling by the OECD has shown that meaningful action is achievable – albeit with a substantial price tag.
To reduce AMR-related deaths by 10%, six actions are required:
- All countries need to have national AMR action plans and 60% of countries commit a budget
- 90% of countries should meet WHO’s minimum infection prevention and control programs at a national level
- All countries need to report surveillance data on AMR and antimicrobial use
- Meaningful reduction in antimicrobial use is taken in agrifood systems
- Strengthened actions to prevent and address the discharge of antimicrobials into the environment
- Mechanisms to support research and development to address AMR should be promoted.
The cost of these initiatives globally is estimated to be $US 52 billion annually – equivalent to 0.5% of the global health budget.
‘The World Bank told us this is a rounding error [in the context of health spending]. This is not an amount of money which cannot be mobilised,’ Mr Cecchini said.
These sentiments were echoed by the Danish Minister for the Interior and Health Sophie Løhde.
‘To tackle [AMR], we need to work much closer together, and your role as pharmacists and life science professionals is key,’ said Minister Løhde at the first plenary session of the 2025 FIP world congress last week. ‘We need your expertise to develop new antimicrobials in the most prudent and effective manner, and to inform and educate our citizens when you meet them in pharmacies all over the world.’
The FIP Copenhagen Declaration on Antimicrobial Resistance, signed by 79 organisations – including The Pharmaceutical Society of Australia – took place on 1 September 2025.
The FIP Declaration outlines clear priorities to address AMR, including global partnership building, promoting vaccination and rational antimicrobial use, protecting medicine supply chains, and advancing evidence on stewardship and outcomes.
[post_title] => OECD sounds the alarm on antimicrobial resistance
[post_excerpt] => A blistering session at the FIP Congress challenged policymakers and health professionals to slow the advance of antimicrobial resistance.
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[post_content] => A study led by Flinders University and the Southern Adelaide Local Health Network shows that the anti-rheumatic medicine methotrexate significantly reduces blood pressure in some patients compared with sulfasalazine – the first clear evidence of this effect in patients newly diagnosed with rheumatoid arthritis (RA).
The common autoimmune disease occurs in around one in 100 people, leading to inflammation and pain in the connective tissue of the joints.
The inflammation caused by RA contributes to high blood pressure by damaging blood vessels, prompting rheumatologists to realise that people with RA don't typically die because of their condition, said lead researcher Professor Arduino Mangoni, Head of Pharmacology at Flinders University College of Medicine and Public Health.
[caption id="attachment_30469" align="alignright" width="216"] Professor Arduino Mangoni[/caption]
‘The main reason people with RA die is because they have a cardiovascular event, such as a myocardial infarction or stroke,’ he said. ‘And this is often because of an excess prevalence of hypertension in these individuals.’
High blood pressure can significantly shorten the life expectancy of people with RA.
‘An epidemiological study quantifying the burden of cardiovascular disease in people with RA concluded that the increased risk imparted by rheumatoid arthritis was similar to diabetes,’ Prof Mangoni added.
What impact did methotrexate have on blood pressure?
Methotrexate is not the only anti-rheumatic medicine that can reduce hypertension, with hydroxychloroquine also being shown to be potentially protective against atherosclerosis, Prof Mangoni said.
‘So we wanted to use the comparator, sulfasalazine, that was still an anti-inflammatory drug [to test in] people with RA, but with very neutral effects on blood pressure,’ he said.
Among patients with RA, the blood pressure of those taking methotrexate differed by an average of 7.4 mmHg compared with people taking sulfasalazine.
‘Most tablets for blood pressure, when given at a moderate to high dose, will have an effect on blood pressure of between 5–10 mmHg – which is normally, at the population level, associated with the reduction in cardiovascular risk of around 10–15%,’ Prof Mangoni said. ‘So by extrapolation, methotrexate compares very well to a traditional antihypertensive medication.’
In patients with RA who don’t have hypertension, methotrexate could also have a preventative effect.
‘That was very well shown in our study, with only a proportion of [participants] having hypertension,’ Prof Mangoni said.
The medicine can also be assumed to lower cardiovascular risk.
‘If there is a positive effect on blood pressure, consequently, you should have a reduced risk of myocardial infarction and stroke, as well as potentially heart failure,’ he said.
Although the impacts of methotrexate on these indications were not specifically tested in the research, the observational results are promising.
‘They are in line with increasing clinical evidence from epidemiological studies that the use of methotrexate is associated with a reduced risk of heart failure, heart attacks and strokes in people with RA,’ Prof Mangoni said.
Is there potential for a new indication?
In people who have both hypertension and RA, there’s a possibility that medicine regimens could change, Prof Mangoni said.
‘The future should address whether the use of methotrexate in this population can allow modification of antihypertensive medications to have a different treatment regimen,’ he said.
‘Methotrexate could also be an adjuvant, but this can only be tested in adequately designed prospective studies.’
Beyond patients with RA, it’s possible that methotrexate might also be indicated for patients with hypertension in the not-too-distant future. But Prof Mangoni concedes this is an ‘increasingly debated topic’.
‘There has only been one study, published 5 years ago, that looks at the effects of low-dose methotrexate on cardiovascular risk in people without RA,’ he said.
‘The idea was that by giving methotrexate to this population that already has a high pro-inflammatory burden, you would actually reduce the risk of atherosclerosis.’
While this study didn’t yield positive results, there are a few reasons behind this that warrant further exploration. The participants in both the intervention and placebo groups did not have particularly high inflammatory markers, and both groups also received folic acid.
‘Folic acid is given together with methotrexate because it has been shown to reduce the toxicity of [the medicine],’ Prof Mangoni said. ‘However, folic acid can also be protective against atherosclerosis. So the fact that it was also given to the placebo arm might have somewhat diluted the protective effects of methotrexate in this trial.’
To best assess the effects in future research, he suggests a trial design comprising three arms: methotrexate plus folic acid, folic acid alone and the placebo group.
‘I suspect that in the future, methotrexate might have value in people without autoimmune diseases, but with a high inflammatory burden,’ he said.
What role does genetics play in the success of therapy?
Another key finding from the research is that methotrexate may not be the right fit for everyone. The medicine has a complex pharmacology, with several mechanisms facilitating its uptake and storage in cells, Prof Mangoni said.
‘Sometimes it is excreted by the cell, so it [reaches] different targets, with each of these targets potentially having genetic variations,’ he said.
Research has shown that there are several genetic polymorphisms that render people more or less responsive to methotrexate in terms of blood pressure reduction.
‘Interestingly, the polymorphisms that we observed [in our research] are different from the polymorphisms that have been previously described,’ Prof Mangoni said.
‘So future research should look for personalised treatment strategies to identify whether these polymorphisms are similar or different to other polymorphisms responsible for blood pressure reduction – and potentially the reduced risk of atherosclerosis.’
In further research, Prof Mangoni is keen to confirm the role of polymorphisms in lowering blood pressure after treatment with methotrexate, with pharmacogenomics determining who is a suitable candidate for the medicine.
‘The idea is to have a comprehensive genetic panel in people who are considered for treatment for methotrexate to determine from the very beginning who is more or less likely to respond,’ he said.
‘The next step is determining whether these polymorphisms could be translated into a non-RA population to see whether this can be tailored to the treatment of methotrexate in these [people].’
[post_title] => Blood pressure benefits seen with methotrexate treatment
[post_excerpt] => New research links methotrexate to a fall in blood pressure. This expert thinks it could lower cardiovascular risk in the general population.
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[post_content] => Parents have reported persistent anxiety about asthma attacks while children miss out. Pharmacists can help to pivot care from treating flare-ups to stopping them.
Australian families are still living with the hidden emotional toll of childhood asthma – even when they believe control is ‘good enough’.
New research, released as part of the launch of Asthma Australia's new multi-year 'Attack Asthma' campaign found that most (60%) of the parents surveyed live with constant anxiety about the next asthma attack, while 57% worry about their child missing out on normal activities.
A reactive approach to asthma management appears to be driving these concerns, with more than half (58%) of parents revealing their child does not use a preventer daily. More than two-thirds (66%) who notice wheeze, cough or breathlessness dismiss these as symptoms of a lingering cold, virus or allergy, rather than asthma. And even when asthma is suspected, nearly a third (30%) still don’t pursue a diagnosis, assuming the symptoms aren’t severe enough.
This National Asthma Week (1–7 September), Australian Pharmacist sat down with Dr Chris Pearce – a Melbourne-based GP who’s on the board of Asthma Australia – about how pharmacists can help to flip the narrative from ‘asthma attack’ to ‘attack asthma’.
Shifting the perspective from reactive to proactive
The difference between asthma and many other chronic conditions is its variability.
So for many decades, asthma care typically began with a reliever (usually a short-acting beta-2 agonist (SABA) as the first step for symptom relief.
‘The asthma action plans in times past emphasised that if you get an [attack] use [salbutamol] Ventolin,’ Dr Pearce said. ‘But we've now moved on to encourage the increased use of preventers to stop the acute attacks.’
The purpose of this strategy is to lessen the impact of asthma on children, along with the parental anxiety that goes with it.
‘The classic example is sport where we used to say, “make sure you've got a blue puffer and use it if you get a bit wheezy”,’ he said.
Even without obvious symptoms such as coughing and shortness of breath, these children were likely experiencing mild symptoms such as tiredness, Dr Pearce said.
‘They weren't reaching their full potential because they had subclinical symptoms,’ he said.
When dispensing preventers and supplying salbutamol, pharmacists can help to transform the approach to asthma management from reactive to proactive.
‘What you do in the intervals between attacks, that’s more important than how you manage an actual attack,’ Dr Pearce said.
‘I say to people, “This is a disease that you have all the time, and we need to manage it all the time because we're trying to maximise your child's potential, rather than just treating attacks.”
Identifying undiagnosed or uncontrolled asthma
Pharmacists are often the first port of call when children experience a minor ailment, Dr Pearce said.
‘That’s when parents front up to the pharmacy and say, “my child has a cough” or “my child's a bit wheezy”,’ he said.
But if you dig a little deeper, you can often unearth the root cause.
‘If you ask a few questions rather than taking it at face value, it might be revealed that they haven't got a runny nose or a temperature, and it could actually be a manifestation of asthma,’ he said.
‘If a child tends to get a cough with every cold and they're coming in for the cough syrup each and every time, that's a bit of a red flag.’
When parents of children who do have confirmed asthma buy salbutamol over-the-counter, pharmacists should monitor how often they purchase it and recommend a formal assessment where appropriate.
‘It’s not about refusing people who want to buy Ventolin, but just planting the seed that a more formal assessment is a good thing,’ Dr Pearce said.
Another indicator can lie in My Health Record.
‘You might see that, unbeknownst to you, there's been a couple of scripts of oral prednisolone from the local hospital,’ he said.
Picking up on poor inhaler technique
Even when patients are using preventer medicines, the wrong inhaler technique can impact treatment outcomes.
This can include anything from not using a spacer when it’s deemed appropriate or not pointing the inhaler in the right direction.
‘I've seen inhalers held six inches away from the mouth,’ Dr Pearce said. ‘I've also seen people who use other devices such as Turbuhalers not click the dial, so they're just inhaling air,’ he said.
When a preventer is first prescribed, Dr Pearce advises pharmacists to demonstrate the correct technique.
‘Then there's a role, especially in children, to check their technique a couple of times a year,’ he said. ‘You can also get the parent to bring the spacer in to check if it’s cracked and broken.’
In children with mild and intermittent asthma, pharmacists can also check whether the preventer dose is appropriate.
‘They grow, but [sometimes] their dose doesn't,’ he said. ‘So you need to occasionally rethink whether they're getting the right dose, and suggest they should go to the GP to get it reviewed.’
Improving adherence and long-term management
Pharmacists can help to reinforce strategies to improve adherence, Dr Pearce said.
‘One of the things about regular maintenance is that it's regular, so it gets into the routine,’ he said. ‘So if you're going to use an inhaler and spacer in the morning and night, having it when you get up and when you go to bed is easier to remember than having to pack it in your school bag every day,’ he said.
Asthma patterns are individual and can vary seasonally. So in all asthma cases, reviewing the pattern of disease is key.
‘For some people, spring has no impact, whereas for others it’s a complete disaster,’ Dr Pearce said.
‘For those patients, my recommendation would be to double the preventer dose for the next couple of months so they continue to be well – regardless of what's going on with the weather.
‘We're keen on a review every 6 months, even in stable children, just to make sure that everyone's keeping on top of it.’
For parents who are concerned about the medication burden of daily preventer use, Dr Pearce said it’s important to emphasise the risks and benefits.
‘There are some side effects from taking inhaled corticosteroids on a regular basis, but they're unusual, and if they do occur they are mild – much less than what you would get from several courses of oral corticosteroids over a year when asthma is not controlled,’ he said.
It’s also important for parents to balance the potential adverse effects from long-term corticosteroid use in a child with mild and untreated asthma, who's not able to concentrate at school.
‘If they’re not able to concentrate at school or perform at their best in sport, in my view the benefits outweigh the risks,’ Dr Pearce said.
It’s also helpful to remind parents that the better controlled their child’s asthma is, the lower their dose of inhaled corticosteroids will need to be.
‘The old asthma action plans used to say, “use your Ventolin when you need it. And if you get sick, take a big dose of your inhaled corticosteroids”,’ Dr Pearce said. ‘But if we use a small dose regularly, it’s much better tolerated by the body.’
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Australian Pharmacist is the official journal for Pharmaceutical Society of Australia Ltd.
