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[post_content] => Missing the mark: why Australians are getting blood pressure checks wrong and what pharmacists can do to help.
More than one in three (34%) of Australian adults have high blood pressure. Of those diagnosed with hypertension, a staggering 68% have uncontrolled blood pressure.
Effectively managing hypertension is the most powerful method of lowering the risk of cardiovascular disease; reducing blood pressure by 5 mm Hg can decrease the probability of adverse cardiovascular events by 10%.
Yet new research found that most Australians don’t know how to measure their blood pressure accurately, nor are they getting advice on how to do so from healthcare professionals – including pharmacists.
Lead researcher Dr Niamh Chapman, Senior Research Fellow at the University of Sydney, explains where patients are getting it wrong, and the vital role pharmacists can play in blood pressure management.
Improper measurement methods are skewing results
While most patients knew they should be seated, have their back supported and remain silent during blood pressure measurement to ensure accurate readings, they weren't aware they should take multiple readings across different intervals conducted over several days.
‘They were doing it really frequently, (either) every week or every day,’ said Dr Chapman.
But the frequency of readings should depend on how they inform care. For example, if a patient needs a review of their blood pressure medications every 6 months, they could take their blood pressure at bi-annual intervals, following recommended steps, before visiting their GP for a script renewal, she said.
Table featured in the Conversation
When participants had a headache, felt unwell or were a bit stressed – this often served as a prompt for them to measure their blood pressure. However, all these factors can cause a variation in blood pressure results.
‘We know high blood pressure doesn't have any symptoms,’ said Dr Chapman. ‘To understand your risk of heart disease, stroke or dementia, that's not the best time to measure your blood pressure.’
Healthcare advice is lacking
Among people who measured their blood pressure at home, less than 20% received advice about how and when to do this from a doctor, nurse or pharmacist, said Dr Chapman.
The at-home devices patients used to measure their blood pressure were also not often clinically validated, which requires testing under an international protocol to assess the device’s reliability to deliver accurate blood pressure readings.
‘The [Therapeutic Goods Administration] only requires devices to be safe in terms of electrical safety, not [in accordance with] this rigorous accuracy testing,’ she said.
In further, as-yet-to-be-published research conducted by the University of Sydney, it was unearthed that most people buy blood pressure monitors from community pharmacists.
‘[But] only half of the devices that were purchased from pharmacies met this standard, and there's very little point-of-sale advice about what to do and what device to buy,’ said Dr Chapman.
Inaccurate readings could inform care decisions
Nearly 80% of people took often inaccurate at-home readings to their next doctor’s appointment. While not following the recommended steps is more likely to result in higher blood pressure readings, a tendency to opt for more favourable results was observed among respondents.
‘They were often taking lots of measurements, then trusting the lowest number, which was also a common [approach among] physicians,’ she said.
These readings were used to inform care decisions, such as confirming a diagnosis of hypertension or deciding whether to add or remove a medicine.
‘Often the home blood pressure measurements were valued by clinicians, because they can be performed more consistently and are more in-depth than one-off readings in a clinic,’ Dr Chapman added.
Pharmacists can improve the accuracy of blood pressure readings
As trusted healthcare providers, pharmacists have several opportunities to relay important messages to patients, said Dr Chapman.
‘Given most people buy their blood pressure device from pharmacies, it’s a great opportunity to provide basic training about how to use it, how to fit the cuff properly, what steps to follow, and when to take action,’ she said.
‘They can also provide education when people are refilling scripts for anti-hypertensive medications.’
First and foremost, pharmacists should advise patients to obtain a validated device according to national and international clinical guidelines, said Dr Chapman. This online tool can be used to check the validation status of blood pressure monitors.
From there, pharmacists should explain how to take a structured approach to at-home blood pressure readings. For example, this could entail taking blood pressure readings once a month, over 3–5 days in the morning and evening, she said.
‘The person should be seated, have 5 minutes rest and take two readings each time they measure their blood pressure, using the average of those.’
This BP Toolkit helps patients take and record their blood pressure averages in a way that's easy for their doctor to digest.
‘To simplify things for both patients and doctors, we created a 10-steps guide for measuring blood pressure, with a report [format] that makes it easier to understand what number to use to inform care,’ said Dr Chapman.
An even bigger role is in the works for pharmacists
As part of the National Hypertension Taskforce to improve blood pressure control, a big part of Dr Chapman’s focus is working with pharmacists to take a team-based approach to hypertension management.
This includes conducting a randomised controlled trial in 2025, in collaboration with PSA, to test the 'BP Toolkit’ – an educational support package designed to improve blood pressure control.
When patients visit the pharmacy for their blood pressure medication, they will be screened and offered a blood pressure check. Those in the intervention group will receive a counselling session with a pharmacist, covering medication adherence, lifestyle changes, action planning, and goal setting.
‘We'll look at delivering formal patient education and counseling, perhaps as part of a MedsCheck, to help improve blood pressure control,’ she said.
‘The goal is to deliver education that supports the patient to know whether or not they should go back to their doctor, and if they do go back to the doctor, what they should talk about.’
Dr Chapman is hoping to develop concrete evidence of the value pharmacists add to chronic disease management.
‘We will be [funding] the pharmacy sites for undertaking the blood pressure measurement and providing an additional payment for delivering the education to the intervention group,’ she said.
‘With that information, we want to demonstrate a fundable model to deliver this [service] that mirrors what happens with [Medicare Benefits Schedule] and [Pharmaceutical Benefits Scheme] items.’
Evidence shows that team-based care involving pharmacists can significantly improve blood pressure control.
‘What we now need to do is demonstrate what an appropriate fee-for-service model is and how this is sustainable and scalable within the context of Australia at a national level,’ said Dr Chapman.
Working closely with local consumer advisors on this research, a key takeout for Dr Chapman is the peace of mind one patient, a stroke survivor, was able to achieve after following recommended at-home blood pressure measurement guidelines.
‘The [relief] they got from measuring their blood pressure in a structured way once a month, instead of every day where it jumps around and they don’t know what the numbers mean, is the most valuable thing as a stroke survivor – allowing them to relax and know that their blood pressure is under control and they're reducing their risk of stroke,’ she said.
[post_title] => The real risks of wrong blood pressure readings
[post_excerpt] => Missing the mark: why Australians are getting blood pressure readings wrong and what pharmacists can do to help.
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[post_content] => Claims about sunscreen’s dangers are targeting young people, and while pharmacists know evidence shows them to be safe and effective, many in the Australian community do not.
The anti-sunscreen movement has picked up speed this year, thanks to the spread of misinformation by influencers on TikTok and other social media platforms. Popular podcasters Joe Rogan and Kristin Cavallari have also led discussions making misleading claims about risks of sunscreen.
Myths about sunscreen’s dangers are fueled by a broader decline of trust in science, said Professor Rachel Neale, Senior Group Leader at the QIMR Berghofer Medical Research Institute.
[caption id="attachment_25005" align="alignright" width="276"]
Rachel Neale from the QIMR Berghofer Medical Research Institute[/caption]
‘People who are good at influencing others are getting their message through because of this loss of trust in authority and science,’ she said.
While this distrust predates COVID-19, the pandemic accelerated skepticism – particularly around the mass rollout of an ‘untested’ vaccine.
‘We're [also] seeing it in things such as the debate about fluoride in the US,’ she added.
While the fears around sunscreen lack concrete evidence, they are often based on a grain of truth albeit taken out of context.
Prof Neale walks through the key myths that are doing the rounds, and how pharmacists can help to debunk them.
Myth: sunscreen causes skin cancer
One prevailing theory circulating on social media is that sunscreen itself causes skin cancer.
‘In observational studies, people are asked “how often do you use sunscreen?”,’ she said. ‘And people who say they use sunscreen more are at higher risk of skin cancer.’
But there are a few important caveats about regular sunscreen users that give these findings context.
‘Sunscreen users are often paler and burn more easily,’ said Prof Neale.
‘People with very pale skin wearing sunscreen are still at higher risk than someone with more deeply pigmented skin who doesn’t use sunscreen.’
Sunscreen use also tends to encourage prolonged sun exposure.
‘Sunscreen allows some UV radiation through. If people are using sunscreen to avoid getting sunburnt, their skin will still receive some UV radiation. And even small doses of radiation can cause harm for people with pale skin,’ she said.
‘Importantly, we have definitive evidence from randomised controlled trials (which overcome the problems of the observational studies) that regularly using sunscreen reduces the risk of skin cancer.’
Myth: oxybenzone is a toxic hormone blocker
Oxybenzone, an active ingredient in chemical sunscreens, absorbs both UV-B and short-range UV-A rays.
But there have been concerns aired on social media that oxybenzone is in fact toxic, acting as a ‘hormone blocker’ or ‘endocrine disruptor’.
This may be particularly worrisome for women who are trying to conceive or during perinatal, perimenopausal or menopausal stages.
Yet these concerns are harder to dismiss, acknowledged Prof Neale.
‘Animal and in vitro studies show some evidence that sunscreen ingredients can affect cell behaviour,’ she said. ‘But the findings are inconsistent – some mouse studies show effects, while others don’t.’
However, the United States Food and Drug Administration (FDA) has conducted studies revealing that certain chemical sunscreen ingredients can be absorbed through the skin into the bloodstream at levels exceeding 0.5 ng/mL.
‘[This absorption occurs] at a level where the FDA has recommended that further investigation is warranted,’ said Prof Neale.
Yet, she emphasised that ‘this is not evidence of harm’.
‘The authors of that study recommend that people continue to use sunscreen because we know that sunscreen is beneficial, and there is no convincing evidence of harm,’ she said.
The Therapeutic Goods Administration regulates primary sunscreen products, and some secondary sunscreens, for use in Australia, which should provide users with confidence that the ingredients and formulations are safe and effective.
Myth: sunscreen reduces vitamin D levels
Yet another social media gripe is that sunscreen reduces vitamin D levels – which is important for musculoskeletal health and has been linked to autoimmune conditions such as multiple sclerosis.
While this claim is not entirely a myth, its significance is often overstated.
Given sunscreen works by blocking or absorbing UVB radiation, which is responsible for triggering vitamin D production in the skin, sunscreen should in theory lower vitamin D synthesis.
However, there is little evidence to suggest this occurs in real-life settings.
For those with very pale skin who are advised to limit sun exposure with clothing and sunscreen, there’s a way to both ensure vitamin D levels are maintained and reduce the risk of skin cancer.
‘Vitamin D supplements are a cheap and effective substitute for sun exposure as a way of maintaining adequate vitamin D status,’ added Prof Neale.
When in doubt, suggest a mineral alternative
For those concerned about chemical absorption, the FDA has classified two mineral sunscreen ingredients – zinc oxide and titanium dioxide – as ‘generally recognised as safe and effective’.
This could particularly assuage parents who are concerned about exposing young children to ingredients that are claimed to be toxic, said Prof Neal.
Mineral sunscreens come in a thicker texture and work immediately by reflecting UV rays. While non-irritating and suitable for sensitive skin, they can leave a white cast on the skin and are harder to blend.
Chemical sunscreens absorb UV rays, taking about 20 minutes before it starts working. While available in an easily blendable light weight texture, some formulations may irritate sensitive skin.
‘A while ago, there were concerns about nanoparticles in the mineral sunscreens, but that's been pretty thoroughly debunked.’
Given the mineral varieties work as a physical UV blocker, they won’t appeal to everyone.
‘They don't spread as easily or feel as nice on the skin,’ she said. ‘But kids probably don't mind as much about the feel of it.’
Leave judgement at the door
With pharmacists being key providers of sun protection advice, it’s important to take a non-judgmental approach when people express concerns about sunscreen – particularly when discussing use in young children.
But it’s important to emphasise that there is no convincing evidence that sunscreens cause harm, while there is strong evidence to suggest sunscreens are beneficial.
‘It's really important that pharmacists support people to continue using sunscreen and to find a sunscreen that works for them – while also recognising that sun protection does not just mean sunscreen,’ said Prof Neale.
‘They should support people to use the entire suite of sun protection measures, such as putting on clothing, avoiding activities during peak UV times if possible, wearing a broad-brimmed hat and seeking shade.’
Move past the myths, focus on the benefits
While it’s important to get the message across about sun safety, Prof Neale said conversations about potential harms of sunscreen shouldn’t be given too much oxygen.
‘We should not be talking about it as much as we have started to, because it's almost like giving people a license to worry about it,’ she said. ‘There is no doubt that the sun causes skin cancer, and we have an epidemic of it.’
Skin cancer on the face is quite common, and while a broad-brimmed hat provides a good level of protection, it doesn't prevent harm from reflected light off the ground.
‘It's really important we emphasise that regular sunscreen use can prevent this,’ said Prof Neale.
Talking about the benefits of sunscreen, rather than the harms, is the best way to dispel these myths.
This includes preventing photoaging and actinic keratosis – which may turn into skin cancer.
‘We spend a fortune on treating sunspots and the treatments can be painful and unpleasant,' she said.
‘One day, maybe we'll find out that there is some confirmed harm from sunscreen, but I'll be very surprised.’
[post_title] => Battling social media misinformation around sunscreen
[post_excerpt] => Sunscreen myths are thriving on social media. An expert explains the evidence-based recommendations to help pharmacists combat misinformation.
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[post_content] => Under a new government plan, pharmacists will be key to dramatically reducing HIV transmission.
Ahead of World AIDS Day (Sunday 1 December), the federal government released the Ninth National HIV Strategy (2024–2030) with the ambitious aim of eliminating HIV transmission by 2030.
Australia has achieved significant progress in reducing HIV transmission over the last decade, marked by a 33% decline in HIV notifications between 2014 and 2023.
Key to this success is increased rates of viral suppression among people living with HIV and the widespread uptake of pre-exposure prophylaxis (PrEP) among HIV-negative people, particularly among gay, bisexual, and other men who have sex with men.
Australia has also surpassed the Joint United Nations Programme on HIV/AIDS (UNAIDS) 2025 target of 86%, with 87% of all people living with HIV achieving viral suppression – reducing the risk of onward transmission to zero when there’s an undetectable viral load.
‘PSA is ready to work with government to investigate how pharmacists can be supported to increase HIV PrEP uptake to eligible people through pharmacist prescribing of PrEP, including long-acting injectables and oral formulations.'
a/prof FEI SIM FPS
‘In the 40 years since HIV/AIDS reached Australia, we have made remarkable progress,’ said Minister for Health and Aged Care Mark Butler. ‘This Strategy marks one of the final steps to achieving the virtual elimination of HIV transmission in Australia.’
We’ve come a long way
The first AIDS diagnosis in Australia occurred in 1982. But over the past four decades, Australia has experienced significant changes in HIV transmission rates.
Following the introduction of HIV testing in 1985, newly diagnosed HIV infections peaked at 2,773 cases in 1987. This dropped by 1,062 the following year and continued to decline to 833 in 1995.
By 1999, the number of new diagnoses had decreased significantly, largely due to the adoption of prevention practices such as safe sex and needle and syringe exchange programs. This downward trend continued into the 21st century, with 552 new HIV diagnoses reported in 2021, attributable to increased testing and widespread use of antiretroviral therapy.
Public perception has also shifted since the 1987 ‘Grim Reaper’ campaign, which aimed to raise awareness but instead instilled widespread fear, stigmatising affected communities.
Advancements in treatment transforming HIV into a manageable condition has led to a shift in public perception. But stigma remains an issue. In 2017, the Australian Survey of Social Attitudes revealed that 52% of the general public indicated they would still behave negatively towards people living with HIV.
Inequitable outcomes
Despite Australia’s successes, improvements in transmission rates have not been experienced across the board – with some populations and regions lagging in testing and PrEP uptake.
HIV diagnosis rates are disproportionately higher among individuals from culturally and linguistically diverse (CALD) backgrounds, with a 21.5% increase in HIV notifications over the past decade, with these patients often diagnosed late. Late diagnosis rates are particularly common among those born in Sub-Saharan Africa , Southeast Asia and Central/South America.
Among Aboriginal and Torres Strait Islander peoples, the HIV notification rate in 2022 was 3.2 per 100,000, compared to 2.2 per 100,000 in the non-Indigenous population.
What are the key aspects of the strategy?
The three key elements of the strategy include reducing new and late diagnoses, promoting understanding and support of U=U (Undetectable = Untransmittable), and implementing and sustaining models of service for intervention – particularly among priority populations.
How does the new national strategy compare to the previous one?
The Eighth National HIV Strategy (2018–2022) and Ninth National HIV Strategy share a commitment to reducing HIV transmission in Australia. But the goals and pathway to achieving this vary.
The Eighth Strategy aimed to meet UNAIDS 90-90-90 targets, focusing on increasing diagnosis, treatment, and viral suppression rates through prioritised expanded access to PrEP, post-exposure prophylaxis (PEP), and harm reduction programs. Addressing stigma and barriers to care for key populations, such as gay and bisexual men, sex workers, and Aboriginal and Torres Strait Islander peoples was also a key focus.
Key achievements under this strategy include allowing people living with HIV who are ineligible for Medicare to access free treatment through government-funded hospital pharmacies in 2023 and providing options for rapid HIV testing and self-test kits in pharmacies under updated Therapeutic Goods Administration regulations.
But the ninth iteration has pushed the envelope further towards virtually eradicating HIV transmission.
This strategy reflects advancements in treatment and prevention technologies, such as long-acting injectable antiretrovirals and expanded use of U=U.
With a higher proportion of men from CALD backgrounds and Aboriginal and Torres Strait Islander peoples acquiring HIV, the ninth strategy emphasises tailored approaches to improve access to care and ensure equitable treatment.
Multicultural organisations and Aboriginal Community Controlled Health Organisations are key to improving awareness of HIV in these communities. This includes design and delivery of culturally appropriate health promotion programs, delivery of peer-based services or directing patients to existing resources.
What’s the role of pharmacists?
Pharmacies are identified as a priority setting within the strategy as an important healthcare service used by priority populations to access HIV care, said a spokesperson for the Department of Health and Aged Care.
‘Pharmacists can play a key role in the virtual elimination of HIV transmission through the four key priorities of the strategy: prevention, testing, treatment and care, and stigma,’ said the spokesperson.
‘In partnership with the HIV sector, the Australian Government is investigating options to increase access to PrEP, including through pharmacists, as recommended by the HIV Taskforce and reflected in the new 9th National HIV Strategy.’
This includes options for promoting, prescribing or supplying PrEP through pharmacies, which is particularly vital among populations with limited access to healthcare services such as in rural or remote areas and CALD communities.
Simplifying PrEP regimen management, such as extending prescription cycles and monitoring requirements beyond 3 months and providing multiple pathology forms for repeat testing could encourage uptake.
However, at this time, there are no plans to change current access arrangements to post-exposure prophylaxis (PEP) for HIV, said the spokesperson.
[caption id="attachment_28347" align="alignnone" width="600"]
PSA National President Associate Professor Fei Sim FPS[/caption]
While PSA shares the ambitious but achievable goal of the government’s updated national HIV strategy to virtually eliminate HIV transmission in Australia by 2030, PSA National President Associate Professor Fei Sim FPS said we can go further in utilising the skills and expertise of pharmacists to reduce barriers to care for people living with or at risk of HIV.
‘[This includes] making medications like PrEP and PEP more accessible to the communities who need them, increasing access to HIV testing and reducing stigma,’ she said.
‘PSA is ready to work with government to investigate how pharmacists can be supported to increase HIV PrEP uptake to eligible people through pharmacist prescribing of PrEP, including long-acting injectables and oral formulations.’
As new formulations come to the Australian market, such as long-acting injectable antiretroviral therapy, pharmacists can play an even greater role in supporting patients at risk of HIV, including both medicine administration and point of care testing.
‘To deliver on the goals of our HIV strategy, all health professionals, including pharmacists, need to do more to combat stigma,’ said A/Prof Sim. ‘This includes increasing awareness and understanding of U=U in the general population and supporting health workers to provide accessible, non-judgmental, and evidence-based care.’
[post_title] => Pharmacists could prescribe PrEP to combat HIV transmission
[post_excerpt] => Under a new national government strategy, pharmacists will be key to dramatically reducing HIV transmission.
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[post_content] => The Therapeutic Goods Administration (TGA) has issued a Serious Scarcity Substitution Instruments (SSSI) to help pharmacists and patients manage the shortage of hormone replacement therapy (HRT) patches.
A global shortage of menopausal hormone therapies (MHT) has persisted throughout 2024, leaving many women 'unable to function’.
Around 13% (260,000) of Australian menopausal women take MHT. But with another 80,000 women estimated to have gone through menopause this year, demand is only set to increase.
But it's not only older women who benefit from using these patches. Younger women undergoing early menopause due to chemotherapy or conditions affecting the ovaries or pituitary gland need oestrogen. So do transgender women and non-binary individuals as part of feminising hormone therapy for gender affirmation.
With shortages of many of these medicines set to persist into 2025, the SSSI allows pharmacists to dispense an alternative brand or strengths to these patients, if appropriate, without a new prescription from the prescriber.
What HRT substitutions are available for patients?
A representative for Sandoz told Australian Pharmacist that the manufacturer is ‘committed to addressing the global supply challenges for MHT and HRT transdermal patches’.
‘In collaboration with the local authorities and global manufacturing partners, we have taken proactive steps to alleviate supply constraints,’ said the spokesperson.
‘Although Estradot (estradiol) registered products will have constrained supply throughout the first half of 2025, as noted on the TGA medicines shortages website, we are pleased to confirm alternative products have received Section 19A conditional approval for release in Australia.’
Medsurge Healthcare, which sources and supplies essential medicines in times of critical need and uncertainty, has also been able to arrange for the supply of alternative products on a temporary basis until the shortages of Australian registered medicines are resolved, a spokesperson for Medsurge told AP.
‘Medsurge was granted temporary S19A approval under section 19A of the Therapeutic Goods Act 1989 and has worked diligently to fill a critical need for patients,’ said the Medsurge spokesperson.
Under Section 19A, the following brands and strengths of HRT patches can be substituted for out-of-stock Estraderm MX and Estradot patches:
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[post_content] => These oft-used medicines have become the analgesia of choice for many prescribers. But care should be taken before prescribing gabapentinoids to certain patients.
Gabapentinoid medicines are widely prescribed in Australia. Considered a safer alternative to opioids for neuropathic pain, there was an 8-fold increase in prescriptions for gabapentinoids from 2012 to 2018 – with 1 in 7 Australians aged 80 and older prescribed a gabapentinoid.
[caption id="attachment_28316" align="aligncenter" width="1280"]
Source – Pregabalin prescribing patterns in Australian general practice, 2012–2018: a cross-sectional study[/caption]
But a new study from Monash University researchers, including pharmacists Miriam Leung and Professor Simon Bell FPS, found that harm can be caused within 2 months of initiation.
Over a 5-year period, the researchers analysed data for 28,293 patients in Victoria who experienced hip fractures.
‘Our research found that patients who were recently dispensed either pregabalin or gabapentin had 30% higher odds of experiencing a hip fracture,’ Prof Bell told Australian Pharmacist.
Who is most at risk?
The link between gabapentinoid use and hip fractures existed across different age groups.
However, the risk of hip fracture associated with gabapentinoid medicines was highest in patients who were frail or had renal impairment, said Prof Bell.
‘Frail older people are prone to falls and fractures,’ he said. ‘One in 25 adults aged 80 years and older experience a hip fracture each year.’
The impact of these incidents can be fatal.
‘Around one in four people who experience a hip fracture die within 12 months,’ said Prof Bell.
How should pharmacists assess and manage falls risk?
For certain neuropathic pain conditions such as postherpetic neuralgia, diabetic neuropathy, and mixed or post-traumatic neuropathy, gabapentinoids such as pregabalin or gabapentin can provide effective relief.
However, while approved by the Australian Therapeutic Goods Administration for refractory focal (partial) epilepsy and neuropathic pain, gabapentin and pregabalin are often prescribed off label – with limited evidence to support efficacy for off-label indications.
In patients who are likely to see some benefit of therapy, pharmacists should advise patients how to minimise risk before dispensing these medicines.
‘The risk of falls is highest at the start of treatment,’ said Prof Bell.
‘Therefore, it’s important that pharmacists and other clinicians advise on strategies to minimise falls risk at this time. This could include avoidance of other falls-risk increasing substances such as alcohol.’
Evaluating what other medicines at-risk patients are prescribed is also an important strategy for preventing harm.
‘It’s known that gabapentinoids can cause side-effects such as drowsiness, sedation and dizziness,’ said Prof Bell.
‘These side-effects may increase the risk of falls, particularly if gabapentinoids are co-administrated with other psychotropic or cardiovascular falls risk medications.’
What impact can dose have on falls risk?
Given risk is highest at the outset of treatment, the starting dose of gabapentinoids can also have an impact on the likelihood of falls.
‘It’s advisable that patients start with a low dose and titrate slowly,’ said Prof Bell. ‘This particularly applies to people who are frail or have renal impairment.’
When is a discussion with the prescriber warranted?
The ongoing need for gabapentinoid treatment for neuropathic pain should be reviewed regularly, said Prof Bell.
‘If patients do not experience benefit after an adequate trial of treatment, then gradual discontinuation may be warranted,’ he said.
However, it’s important to advise people who take a gabapentinoid medicine that they shouldn’t stop taking their medication without first speaking with their prescriber or pharmacist first.
‘Stopping gabapentinoid medications abruptly can cause withdrawal symptoms,’ Prof Bell added.
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[post_content] => Missing the mark: why Australians are getting blood pressure checks wrong and what pharmacists can do to help.
More than one in three (34%) of Australian adults have high blood pressure. Of those diagnosed with hypertension, a staggering 68% have uncontrolled blood pressure.
Effectively managing hypertension is the most powerful method of lowering the risk of cardiovascular disease; reducing blood pressure by 5 mm Hg can decrease the probability of adverse cardiovascular events by 10%.
Yet new research found that most Australians don’t know how to measure their blood pressure accurately, nor are they getting advice on how to do so from healthcare professionals – including pharmacists.
Lead researcher Dr Niamh Chapman, Senior Research Fellow at the University of Sydney, explains where patients are getting it wrong, and the vital role pharmacists can play in blood pressure management.
Improper measurement methods are skewing results
While most patients knew they should be seated, have their back supported and remain silent during blood pressure measurement to ensure accurate readings, they weren't aware they should take multiple readings across different intervals conducted over several days.
‘They were doing it really frequently, (either) every week or every day,’ said Dr Chapman.
But the frequency of readings should depend on how they inform care. For example, if a patient needs a review of their blood pressure medications every 6 months, they could take their blood pressure at bi-annual intervals, following recommended steps, before visiting their GP for a script renewal, she said.
Table featured in the Conversation
When participants had a headache, felt unwell or were a bit stressed – this often served as a prompt for them to measure their blood pressure. However, all these factors can cause a variation in blood pressure results.
‘We know high blood pressure doesn't have any symptoms,’ said Dr Chapman. ‘To understand your risk of heart disease, stroke or dementia, that's not the best time to measure your blood pressure.’
Healthcare advice is lacking
Among people who measured their blood pressure at home, less than 20% received advice about how and when to do this from a doctor, nurse or pharmacist, said Dr Chapman.
The at-home devices patients used to measure their blood pressure were also not often clinically validated, which requires testing under an international protocol to assess the device’s reliability to deliver accurate blood pressure readings.
‘The [Therapeutic Goods Administration] only requires devices to be safe in terms of electrical safety, not [in accordance with] this rigorous accuracy testing,’ she said.
In further, as-yet-to-be-published research conducted by the University of Sydney, it was unearthed that most people buy blood pressure monitors from community pharmacists.
‘[But] only half of the devices that were purchased from pharmacies met this standard, and there's very little point-of-sale advice about what to do and what device to buy,’ said Dr Chapman.
Inaccurate readings could inform care decisions
Nearly 80% of people took often inaccurate at-home readings to their next doctor’s appointment. While not following the recommended steps is more likely to result in higher blood pressure readings, a tendency to opt for more favourable results was observed among respondents.
‘They were often taking lots of measurements, then trusting the lowest number, which was also a common [approach among] physicians,’ she said.
These readings were used to inform care decisions, such as confirming a diagnosis of hypertension or deciding whether to add or remove a medicine.
‘Often the home blood pressure measurements were valued by clinicians, because they can be performed more consistently and are more in-depth than one-off readings in a clinic,’ Dr Chapman added.
Pharmacists can improve the accuracy of blood pressure readings
As trusted healthcare providers, pharmacists have several opportunities to relay important messages to patients, said Dr Chapman.
‘Given most people buy their blood pressure device from pharmacies, it’s a great opportunity to provide basic training about how to use it, how to fit the cuff properly, what steps to follow, and when to take action,’ she said.
‘They can also provide education when people are refilling scripts for anti-hypertensive medications.’
First and foremost, pharmacists should advise patients to obtain a validated device according to national and international clinical guidelines, said Dr Chapman. This online tool can be used to check the validation status of blood pressure monitors.
From there, pharmacists should explain how to take a structured approach to at-home blood pressure readings. For example, this could entail taking blood pressure readings once a month, over 3–5 days in the morning and evening, she said.
‘The person should be seated, have 5 minutes rest and take two readings each time they measure their blood pressure, using the average of those.’
This BP Toolkit helps patients take and record their blood pressure averages in a way that's easy for their doctor to digest.
‘To simplify things for both patients and doctors, we created a 10-steps guide for measuring blood pressure, with a report [format] that makes it easier to understand what number to use to inform care,’ said Dr Chapman.
An even bigger role is in the works for pharmacists
As part of the National Hypertension Taskforce to improve blood pressure control, a big part of Dr Chapman’s focus is working with pharmacists to take a team-based approach to hypertension management.
This includes conducting a randomised controlled trial in 2025, in collaboration with PSA, to test the 'BP Toolkit’ – an educational support package designed to improve blood pressure control.
When patients visit the pharmacy for their blood pressure medication, they will be screened and offered a blood pressure check. Those in the intervention group will receive a counselling session with a pharmacist, covering medication adherence, lifestyle changes, action planning, and goal setting.
‘We'll look at delivering formal patient education and counseling, perhaps as part of a MedsCheck, to help improve blood pressure control,’ she said.
‘The goal is to deliver education that supports the patient to know whether or not they should go back to their doctor, and if they do go back to the doctor, what they should talk about.’
Dr Chapman is hoping to develop concrete evidence of the value pharmacists add to chronic disease management.
‘We will be [funding] the pharmacy sites for undertaking the blood pressure measurement and providing an additional payment for delivering the education to the intervention group,’ she said.
‘With that information, we want to demonstrate a fundable model to deliver this [service] that mirrors what happens with [Medicare Benefits Schedule] and [Pharmaceutical Benefits Scheme] items.’
Evidence shows that team-based care involving pharmacists can significantly improve blood pressure control.
‘What we now need to do is demonstrate what an appropriate fee-for-service model is and how this is sustainable and scalable within the context of Australia at a national level,’ said Dr Chapman.
Working closely with local consumer advisors on this research, a key takeout for Dr Chapman is the peace of mind one patient, a stroke survivor, was able to achieve after following recommended at-home blood pressure measurement guidelines.
‘The [relief] they got from measuring their blood pressure in a structured way once a month, instead of every day where it jumps around and they don’t know what the numbers mean, is the most valuable thing as a stroke survivor – allowing them to relax and know that their blood pressure is under control and they're reducing their risk of stroke,’ she said.
[post_title] => The real risks of wrong blood pressure readings
[post_excerpt] => Missing the mark: why Australians are getting blood pressure readings wrong and what pharmacists can do to help.
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[post_content] => Claims about sunscreen’s dangers are targeting young people, and while pharmacists know evidence shows them to be safe and effective, many in the Australian community do not.
The anti-sunscreen movement has picked up speed this year, thanks to the spread of misinformation by influencers on TikTok and other social media platforms. Popular podcasters Joe Rogan and Kristin Cavallari have also led discussions making misleading claims about risks of sunscreen.
Myths about sunscreen’s dangers are fueled by a broader decline of trust in science, said Professor Rachel Neale, Senior Group Leader at the QIMR Berghofer Medical Research Institute.
[caption id="attachment_25005" align="alignright" width="276"] Rachel Neale from the QIMR Berghofer Medical Research Institute[/caption]
‘People who are good at influencing others are getting their message through because of this loss of trust in authority and science,’ she said.
While this distrust predates COVID-19, the pandemic accelerated skepticism – particularly around the mass rollout of an ‘untested’ vaccine.
‘We're [also] seeing it in things such as the debate about fluoride in the US,’ she added.
While the fears around sunscreen lack concrete evidence, they are often based on a grain of truth albeit taken out of context.
Prof Neale walks through the key myths that are doing the rounds, and how pharmacists can help to debunk them.
Myth: sunscreen causes skin cancer
One prevailing theory circulating on social media is that sunscreen itself causes skin cancer.
‘In observational studies, people are asked “how often do you use sunscreen?”,’ she said. ‘And people who say they use sunscreen more are at higher risk of skin cancer.’
But there are a few important caveats about regular sunscreen users that give these findings context.
‘Sunscreen users are often paler and burn more easily,’ said Prof Neale.
‘People with very pale skin wearing sunscreen are still at higher risk than someone with more deeply pigmented skin who doesn’t use sunscreen.’
Sunscreen use also tends to encourage prolonged sun exposure.
‘Sunscreen allows some UV radiation through. If people are using sunscreen to avoid getting sunburnt, their skin will still receive some UV radiation. And even small doses of radiation can cause harm for people with pale skin,’ she said.
‘Importantly, we have definitive evidence from randomised controlled trials (which overcome the problems of the observational studies) that regularly using sunscreen reduces the risk of skin cancer.’
Myth: oxybenzone is a toxic hormone blocker
Oxybenzone, an active ingredient in chemical sunscreens, absorbs both UV-B and short-range UV-A rays.
But there have been concerns aired on social media that oxybenzone is in fact toxic, acting as a ‘hormone blocker’ or ‘endocrine disruptor’.
This may be particularly worrisome for women who are trying to conceive or during perinatal, perimenopausal or menopausal stages.
Yet these concerns are harder to dismiss, acknowledged Prof Neale.
‘Animal and in vitro studies show some evidence that sunscreen ingredients can affect cell behaviour,’ she said. ‘But the findings are inconsistent – some mouse studies show effects, while others don’t.’
However, the United States Food and Drug Administration (FDA) has conducted studies revealing that certain chemical sunscreen ingredients can be absorbed through the skin into the bloodstream at levels exceeding 0.5 ng/mL.
‘[This absorption occurs] at a level where the FDA has recommended that further investigation is warranted,’ said Prof Neale.
Yet, she emphasised that ‘this is not evidence of harm’.
‘The authors of that study recommend that people continue to use sunscreen because we know that sunscreen is beneficial, and there is no convincing evidence of harm,’ she said.
The Therapeutic Goods Administration regulates primary sunscreen products, and some secondary sunscreens, for use in Australia, which should provide users with confidence that the ingredients and formulations are safe and effective.
Myth: sunscreen reduces vitamin D levels
Yet another social media gripe is that sunscreen reduces vitamin D levels – which is important for musculoskeletal health and has been linked to autoimmune conditions such as multiple sclerosis.
While this claim is not entirely a myth, its significance is often overstated.
Given sunscreen works by blocking or absorbing UVB radiation, which is responsible for triggering vitamin D production in the skin, sunscreen should in theory lower vitamin D synthesis.
However, there is little evidence to suggest this occurs in real-life settings.
For those with very pale skin who are advised to limit sun exposure with clothing and sunscreen, there’s a way to both ensure vitamin D levels are maintained and reduce the risk of skin cancer.
‘Vitamin D supplements are a cheap and effective substitute for sun exposure as a way of maintaining adequate vitamin D status,’ added Prof Neale.
When in doubt, suggest a mineral alternative
For those concerned about chemical absorption, the FDA has classified two mineral sunscreen ingredients – zinc oxide and titanium dioxide – as ‘generally recognised as safe and effective’.
This could particularly assuage parents who are concerned about exposing young children to ingredients that are claimed to be toxic, said Prof Neal.
Mineral sunscreens come in a thicker texture and work immediately by reflecting UV rays. While non-irritating and suitable for sensitive skin, they can leave a white cast on the skin and are harder to blend.
Chemical sunscreens absorb UV rays, taking about 20 minutes before it starts working. While available in an easily blendable light weight texture, some formulations may irritate sensitive skin.
‘A while ago, there were concerns about nanoparticles in the mineral sunscreens, but that's been pretty thoroughly debunked.’
Given the mineral varieties work as a physical UV blocker, they won’t appeal to everyone.
‘They don't spread as easily or feel as nice on the skin,’ she said. ‘But kids probably don't mind as much about the feel of it.’
Leave judgement at the door
With pharmacists being key providers of sun protection advice, it’s important to take a non-judgmental approach when people express concerns about sunscreen – particularly when discussing use in young children.
But it’s important to emphasise that there is no convincing evidence that sunscreens cause harm, while there is strong evidence to suggest sunscreens are beneficial.
‘It's really important that pharmacists support people to continue using sunscreen and to find a sunscreen that works for them – while also recognising that sun protection does not just mean sunscreen,’ said Prof Neale.
‘They should support people to use the entire suite of sun protection measures, such as putting on clothing, avoiding activities during peak UV times if possible, wearing a broad-brimmed hat and seeking shade.’
Move past the myths, focus on the benefits
While it’s important to get the message across about sun safety, Prof Neale said conversations about potential harms of sunscreen shouldn’t be given too much oxygen.
‘We should not be talking about it as much as we have started to, because it's almost like giving people a license to worry about it,’ she said. ‘There is no doubt that the sun causes skin cancer, and we have an epidemic of it.’
Skin cancer on the face is quite common, and while a broad-brimmed hat provides a good level of protection, it doesn't prevent harm from reflected light off the ground.
‘It's really important we emphasise that regular sunscreen use can prevent this,’ said Prof Neale.
Talking about the benefits of sunscreen, rather than the harms, is the best way to dispel these myths.
This includes preventing photoaging and actinic keratosis – which may turn into skin cancer.
‘We spend a fortune on treating sunspots and the treatments can be painful and unpleasant,' she said.
‘One day, maybe we'll find out that there is some confirmed harm from sunscreen, but I'll be very surprised.’
[post_title] => Battling social media misinformation around sunscreen
[post_excerpt] => Sunscreen myths are thriving on social media. An expert explains the evidence-based recommendations to help pharmacists combat misinformation.
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[post_content] => Under a new government plan, pharmacists will be key to dramatically reducing HIV transmission.
Ahead of World AIDS Day (Sunday 1 December), the federal government released the Ninth National HIV Strategy (2024–2030) with the ambitious aim of eliminating HIV transmission by 2030.
Australia has achieved significant progress in reducing HIV transmission over the last decade, marked by a 33% decline in HIV notifications between 2014 and 2023.
Key to this success is increased rates of viral suppression among people living with HIV and the widespread uptake of pre-exposure prophylaxis (PrEP) among HIV-negative people, particularly among gay, bisexual, and other men who have sex with men.
Australia has also surpassed the Joint United Nations Programme on HIV/AIDS (UNAIDS) 2025 target of 86%, with 87% of all people living with HIV achieving viral suppression – reducing the risk of onward transmission to zero when there’s an undetectable viral load.
‘PSA is ready to work with government to investigate how pharmacists can be supported to increase HIV PrEP uptake to eligible people through pharmacist prescribing of PrEP, including long-acting injectables and oral formulations.'
a/prof FEI SIM FPS
‘In the 40 years since HIV/AIDS reached Australia, we have made remarkable progress,’ said Minister for Health and Aged Care Mark Butler. ‘This Strategy marks one of the final steps to achieving the virtual elimination of HIV transmission in Australia.’
We’ve come a long way
The first AIDS diagnosis in Australia occurred in 1982. But over the past four decades, Australia has experienced significant changes in HIV transmission rates.
Following the introduction of HIV testing in 1985, newly diagnosed HIV infections peaked at 2,773 cases in 1987. This dropped by 1,062 the following year and continued to decline to 833 in 1995.
By 1999, the number of new diagnoses had decreased significantly, largely due to the adoption of prevention practices such as safe sex and needle and syringe exchange programs. This downward trend continued into the 21st century, with 552 new HIV diagnoses reported in 2021, attributable to increased testing and widespread use of antiretroviral therapy.
Public perception has also shifted since the 1987 ‘Grim Reaper’ campaign, which aimed to raise awareness but instead instilled widespread fear, stigmatising affected communities.
Advancements in treatment transforming HIV into a manageable condition has led to a shift in public perception. But stigma remains an issue. In 2017, the Australian Survey of Social Attitudes revealed that 52% of the general public indicated they would still behave negatively towards people living with HIV.
Inequitable outcomes
Despite Australia’s successes, improvements in transmission rates have not been experienced across the board – with some populations and regions lagging in testing and PrEP uptake.
HIV diagnosis rates are disproportionately higher among individuals from culturally and linguistically diverse (CALD) backgrounds, with a 21.5% increase in HIV notifications over the past decade, with these patients often diagnosed late. Late diagnosis rates are particularly common among those born in Sub-Saharan Africa , Southeast Asia and Central/South America.
Among Aboriginal and Torres Strait Islander peoples, the HIV notification rate in 2022 was 3.2 per 100,000, compared to 2.2 per 100,000 in the non-Indigenous population.
What are the key aspects of the strategy?
The three key elements of the strategy include reducing new and late diagnoses, promoting understanding and support of U=U (Undetectable = Untransmittable), and implementing and sustaining models of service for intervention – particularly among priority populations.
How does the new national strategy compare to the previous one?
The Eighth National HIV Strategy (2018–2022) and Ninth National HIV Strategy share a commitment to reducing HIV transmission in Australia. But the goals and pathway to achieving this vary.
The Eighth Strategy aimed to meet UNAIDS 90-90-90 targets, focusing on increasing diagnosis, treatment, and viral suppression rates through prioritised expanded access to PrEP, post-exposure prophylaxis (PEP), and harm reduction programs. Addressing stigma and barriers to care for key populations, such as gay and bisexual men, sex workers, and Aboriginal and Torres Strait Islander peoples was also a key focus.
Key achievements under this strategy include allowing people living with HIV who are ineligible for Medicare to access free treatment through government-funded hospital pharmacies in 2023 and providing options for rapid HIV testing and self-test kits in pharmacies under updated Therapeutic Goods Administration regulations.
But the ninth iteration has pushed the envelope further towards virtually eradicating HIV transmission.
This strategy reflects advancements in treatment and prevention technologies, such as long-acting injectable antiretrovirals and expanded use of U=U.
With a higher proportion of men from CALD backgrounds and Aboriginal and Torres Strait Islander peoples acquiring HIV, the ninth strategy emphasises tailored approaches to improve access to care and ensure equitable treatment.
Multicultural organisations and Aboriginal Community Controlled Health Organisations are key to improving awareness of HIV in these communities. This includes design and delivery of culturally appropriate health promotion programs, delivery of peer-based services or directing patients to existing resources.
What’s the role of pharmacists?
Pharmacies are identified as a priority setting within the strategy as an important healthcare service used by priority populations to access HIV care, said a spokesperson for the Department of Health and Aged Care.
‘Pharmacists can play a key role in the virtual elimination of HIV transmission through the four key priorities of the strategy: prevention, testing, treatment and care, and stigma,’ said the spokesperson.
‘In partnership with the HIV sector, the Australian Government is investigating options to increase access to PrEP, including through pharmacists, as recommended by the HIV Taskforce and reflected in the new 9th National HIV Strategy.’
This includes options for promoting, prescribing or supplying PrEP through pharmacies, which is particularly vital among populations with limited access to healthcare services such as in rural or remote areas and CALD communities.
Simplifying PrEP regimen management, such as extending prescription cycles and monitoring requirements beyond 3 months and providing multiple pathology forms for repeat testing could encourage uptake.
However, at this time, there are no plans to change current access arrangements to post-exposure prophylaxis (PEP) for HIV, said the spokesperson.
[caption id="attachment_28347" align="alignnone" width="600"] PSA National President Associate Professor Fei Sim FPS[/caption]
While PSA shares the ambitious but achievable goal of the government’s updated national HIV strategy to virtually eliminate HIV transmission in Australia by 2030, PSA National President Associate Professor Fei Sim FPS said we can go further in utilising the skills and expertise of pharmacists to reduce barriers to care for people living with or at risk of HIV.
‘[This includes] making medications like PrEP and PEP more accessible to the communities who need them, increasing access to HIV testing and reducing stigma,’ she said.
‘PSA is ready to work with government to investigate how pharmacists can be supported to increase HIV PrEP uptake to eligible people through pharmacist prescribing of PrEP, including long-acting injectables and oral formulations.’
As new formulations come to the Australian market, such as long-acting injectable antiretroviral therapy, pharmacists can play an even greater role in supporting patients at risk of HIV, including both medicine administration and point of care testing.
‘To deliver on the goals of our HIV strategy, all health professionals, including pharmacists, need to do more to combat stigma,’ said A/Prof Sim. ‘This includes increasing awareness and understanding of U=U in the general population and supporting health workers to provide accessible, non-judgmental, and evidence-based care.’
[post_title] => Pharmacists could prescribe PrEP to combat HIV transmission
[post_excerpt] => Under a new national government strategy, pharmacists will be key to dramatically reducing HIV transmission.
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[post_content] => The Therapeutic Goods Administration (TGA) has issued a Serious Scarcity Substitution Instruments (SSSI) to help pharmacists and patients manage the shortage of hormone replacement therapy (HRT) patches.
A global shortage of menopausal hormone therapies (MHT) has persisted throughout 2024, leaving many women 'unable to function’.
Around 13% (260,000) of Australian menopausal women take MHT. But with another 80,000 women estimated to have gone through menopause this year, demand is only set to increase.
But it's not only older women who benefit from using these patches. Younger women undergoing early menopause due to chemotherapy or conditions affecting the ovaries or pituitary gland need oestrogen. So do transgender women and non-binary individuals as part of feminising hormone therapy for gender affirmation.
With shortages of many of these medicines set to persist into 2025, the SSSI allows pharmacists to dispense an alternative brand or strengths to these patients, if appropriate, without a new prescription from the prescriber.
What HRT substitutions are available for patients?
A representative for Sandoz told Australian Pharmacist that the manufacturer is ‘committed to addressing the global supply challenges for MHT and HRT transdermal patches’.
‘In collaboration with the local authorities and global manufacturing partners, we have taken proactive steps to alleviate supply constraints,’ said the spokesperson.
‘Although Estradot (estradiol) registered products will have constrained supply throughout the first half of 2025, as noted on the TGA medicines shortages website, we are pleased to confirm alternative products have received Section 19A conditional approval for release in Australia.’
Medsurge Healthcare, which sources and supplies essential medicines in times of critical need and uncertainty, has also been able to arrange for the supply of alternative products on a temporary basis until the shortages of Australian registered medicines are resolved, a spokesperson for Medsurge told AP.
‘Medsurge was granted temporary S19A approval under section 19A of the Therapeutic Goods Act 1989 and has worked diligently to fill a critical need for patients,’ said the Medsurge spokesperson.
Under Section 19A, the following brands and strengths of HRT patches can be substituted for out-of-stock Estraderm MX and Estradot patches:
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[post_content] => These oft-used medicines have become the analgesia of choice for many prescribers. But care should be taken before prescribing gabapentinoids to certain patients.
Gabapentinoid medicines are widely prescribed in Australia. Considered a safer alternative to opioids for neuropathic pain, there was an 8-fold increase in prescriptions for gabapentinoids from 2012 to 2018 – with 1 in 7 Australians aged 80 and older prescribed a gabapentinoid.
[caption id="attachment_28316" align="aligncenter" width="1280"] Source – Pregabalin prescribing patterns in Australian general practice, 2012–2018: a cross-sectional study[/caption]
But a new study from Monash University researchers, including pharmacists Miriam Leung and Professor Simon Bell FPS, found that harm can be caused within 2 months of initiation.
Over a 5-year period, the researchers analysed data for 28,293 patients in Victoria who experienced hip fractures.
‘Our research found that patients who were recently dispensed either pregabalin or gabapentin had 30% higher odds of experiencing a hip fracture,’ Prof Bell told Australian Pharmacist.
Who is most at risk?
The link between gabapentinoid use and hip fractures existed across different age groups.
However, the risk of hip fracture associated with gabapentinoid medicines was highest in patients who were frail or had renal impairment, said Prof Bell.
‘Frail older people are prone to falls and fractures,’ he said. ‘One in 25 adults aged 80 years and older experience a hip fracture each year.’
The impact of these incidents can be fatal.
‘Around one in four people who experience a hip fracture die within 12 months,’ said Prof Bell.
How should pharmacists assess and manage falls risk?
For certain neuropathic pain conditions such as postherpetic neuralgia, diabetic neuropathy, and mixed or post-traumatic neuropathy, gabapentinoids such as pregabalin or gabapentin can provide effective relief.
However, while approved by the Australian Therapeutic Goods Administration for refractory focal (partial) epilepsy and neuropathic pain, gabapentin and pregabalin are often prescribed off label – with limited evidence to support efficacy for off-label indications.
In patients who are likely to see some benefit of therapy, pharmacists should advise patients how to minimise risk before dispensing these medicines.
‘The risk of falls is highest at the start of treatment,’ said Prof Bell.
‘Therefore, it’s important that pharmacists and other clinicians advise on strategies to minimise falls risk at this time. This could include avoidance of other falls-risk increasing substances such as alcohol.’
Evaluating what other medicines at-risk patients are prescribed is also an important strategy for preventing harm.
‘It’s known that gabapentinoids can cause side-effects such as drowsiness, sedation and dizziness,’ said Prof Bell.
‘These side-effects may increase the risk of falls, particularly if gabapentinoids are co-administrated with other psychotropic or cardiovascular falls risk medications.’
What impact can dose have on falls risk?
Given risk is highest at the outset of treatment, the starting dose of gabapentinoids can also have an impact on the likelihood of falls.
‘It’s advisable that patients start with a low dose and titrate slowly,’ said Prof Bell. ‘This particularly applies to people who are frail or have renal impairment.’
When is a discussion with the prescriber warranted?
The ongoing need for gabapentinoid treatment for neuropathic pain should be reviewed regularly, said Prof Bell.
‘If patients do not experience benefit after an adequate trial of treatment, then gradual discontinuation may be warranted,’ he said.
However, it’s important to advise people who take a gabapentinoid medicine that they shouldn’t stop taking their medication without first speaking with their prescriber or pharmacist first.
‘Stopping gabapentinoid medications abruptly can cause withdrawal symptoms,’ Prof Bell added.
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[post_content] => Missing the mark: why Australians are getting blood pressure checks wrong and what pharmacists can do to help.
More than one in three (34%) of Australian adults have high blood pressure. Of those diagnosed with hypertension, a staggering 68% have uncontrolled blood pressure.
Effectively managing hypertension is the most powerful method of lowering the risk of cardiovascular disease; reducing blood pressure by 5 mm Hg can decrease the probability of adverse cardiovascular events by 10%.
Yet new research found that most Australians don’t know how to measure their blood pressure accurately, nor are they getting advice on how to do so from healthcare professionals – including pharmacists.
Lead researcher Dr Niamh Chapman, Senior Research Fellow at the University of Sydney, explains where patients are getting it wrong, and the vital role pharmacists can play in blood pressure management.
Improper measurement methods are skewing results
While most patients knew they should be seated, have their back supported and remain silent during blood pressure measurement to ensure accurate readings, they weren't aware they should take multiple readings across different intervals conducted over several days.
‘They were doing it really frequently, (either) every week or every day,’ said Dr Chapman.
But the frequency of readings should depend on how they inform care. For example, if a patient needs a review of their blood pressure medications every 6 months, they could take their blood pressure at bi-annual intervals, following recommended steps, before visiting their GP for a script renewal, she said.
Table featured in the Conversation
When participants had a headache, felt unwell or were a bit stressed – this often served as a prompt for them to measure their blood pressure. However, all these factors can cause a variation in blood pressure results.
‘We know high blood pressure doesn't have any symptoms,’ said Dr Chapman. ‘To understand your risk of heart disease, stroke or dementia, that's not the best time to measure your blood pressure.’
Healthcare advice is lacking
Among people who measured their blood pressure at home, less than 20% received advice about how and when to do this from a doctor, nurse or pharmacist, said Dr Chapman.
The at-home devices patients used to measure their blood pressure were also not often clinically validated, which requires testing under an international protocol to assess the device’s reliability to deliver accurate blood pressure readings.
‘The [Therapeutic Goods Administration] only requires devices to be safe in terms of electrical safety, not [in accordance with] this rigorous accuracy testing,’ she said.
In further, as-yet-to-be-published research conducted by the University of Sydney, it was unearthed that most people buy blood pressure monitors from community pharmacists.
‘[But] only half of the devices that were purchased from pharmacies met this standard, and there's very little point-of-sale advice about what to do and what device to buy,’ said Dr Chapman.
Inaccurate readings could inform care decisions
Nearly 80% of people took often inaccurate at-home readings to their next doctor’s appointment. While not following the recommended steps is more likely to result in higher blood pressure readings, a tendency to opt for more favourable results was observed among respondents.
‘They were often taking lots of measurements, then trusting the lowest number, which was also a common [approach among] physicians,’ she said.
These readings were used to inform care decisions, such as confirming a diagnosis of hypertension or deciding whether to add or remove a medicine.
‘Often the home blood pressure measurements were valued by clinicians, because they can be performed more consistently and are more in-depth than one-off readings in a clinic,’ Dr Chapman added.
Pharmacists can improve the accuracy of blood pressure readings
As trusted healthcare providers, pharmacists have several opportunities to relay important messages to patients, said Dr Chapman.
‘Given most people buy their blood pressure device from pharmacies, it’s a great opportunity to provide basic training about how to use it, how to fit the cuff properly, what steps to follow, and when to take action,’ she said.
‘They can also provide education when people are refilling scripts for anti-hypertensive medications.’
First and foremost, pharmacists should advise patients to obtain a validated device according to national and international clinical guidelines, said Dr Chapman. This online tool can be used to check the validation status of blood pressure monitors.
From there, pharmacists should explain how to take a structured approach to at-home blood pressure readings. For example, this could entail taking blood pressure readings once a month, over 3–5 days in the morning and evening, she said.
‘The person should be seated, have 5 minutes rest and take two readings each time they measure their blood pressure, using the average of those.’
This BP Toolkit helps patients take and record their blood pressure averages in a way that's easy for their doctor to digest.
‘To simplify things for both patients and doctors, we created a 10-steps guide for measuring blood pressure, with a report [format] that makes it easier to understand what number to use to inform care,’ said Dr Chapman.
An even bigger role is in the works for pharmacists
As part of the National Hypertension Taskforce to improve blood pressure control, a big part of Dr Chapman’s focus is working with pharmacists to take a team-based approach to hypertension management.
This includes conducting a randomised controlled trial in 2025, in collaboration with PSA, to test the 'BP Toolkit’ – an educational support package designed to improve blood pressure control.
When patients visit the pharmacy for their blood pressure medication, they will be screened and offered a blood pressure check. Those in the intervention group will receive a counselling session with a pharmacist, covering medication adherence, lifestyle changes, action planning, and goal setting.
‘We'll look at delivering formal patient education and counseling, perhaps as part of a MedsCheck, to help improve blood pressure control,’ she said.
‘The goal is to deliver education that supports the patient to know whether or not they should go back to their doctor, and if they do go back to the doctor, what they should talk about.’
Dr Chapman is hoping to develop concrete evidence of the value pharmacists add to chronic disease management.
‘We will be [funding] the pharmacy sites for undertaking the blood pressure measurement and providing an additional payment for delivering the education to the intervention group,’ she said.
‘With that information, we want to demonstrate a fundable model to deliver this [service] that mirrors what happens with [Medicare Benefits Schedule] and [Pharmaceutical Benefits Scheme] items.’
Evidence shows that team-based care involving pharmacists can significantly improve blood pressure control.
‘What we now need to do is demonstrate what an appropriate fee-for-service model is and how this is sustainable and scalable within the context of Australia at a national level,’ said Dr Chapman.
Working closely with local consumer advisors on this research, a key takeout for Dr Chapman is the peace of mind one patient, a stroke survivor, was able to achieve after following recommended at-home blood pressure measurement guidelines.
‘The [relief] they got from measuring their blood pressure in a structured way once a month, instead of every day where it jumps around and they don’t know what the numbers mean, is the most valuable thing as a stroke survivor – allowing them to relax and know that their blood pressure is under control and they're reducing their risk of stroke,’ she said.
[post_title] => The real risks of wrong blood pressure readings
[post_excerpt] => Missing the mark: why Australians are getting blood pressure readings wrong and what pharmacists can do to help.
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[post_content] => Claims about sunscreen’s dangers are targeting young people, and while pharmacists know evidence shows them to be safe and effective, many in the Australian community do not.
The anti-sunscreen movement has picked up speed this year, thanks to the spread of misinformation by influencers on TikTok and other social media platforms. Popular podcasters Joe Rogan and Kristin Cavallari have also led discussions making misleading claims about risks of sunscreen.
Myths about sunscreen’s dangers are fueled by a broader decline of trust in science, said Professor Rachel Neale, Senior Group Leader at the QIMR Berghofer Medical Research Institute.
[caption id="attachment_25005" align="alignright" width="276"] Rachel Neale from the QIMR Berghofer Medical Research Institute[/caption]
‘People who are good at influencing others are getting their message through because of this loss of trust in authority and science,’ she said.
While this distrust predates COVID-19, the pandemic accelerated skepticism – particularly around the mass rollout of an ‘untested’ vaccine.
‘We're [also] seeing it in things such as the debate about fluoride in the US,’ she added.
While the fears around sunscreen lack concrete evidence, they are often based on a grain of truth albeit taken out of context.
Prof Neale walks through the key myths that are doing the rounds, and how pharmacists can help to debunk them.
Myth: sunscreen causes skin cancer
One prevailing theory circulating on social media is that sunscreen itself causes skin cancer.
‘In observational studies, people are asked “how often do you use sunscreen?”,’ she said. ‘And people who say they use sunscreen more are at higher risk of skin cancer.’
But there are a few important caveats about regular sunscreen users that give these findings context.
‘Sunscreen users are often paler and burn more easily,’ said Prof Neale.
‘People with very pale skin wearing sunscreen are still at higher risk than someone with more deeply pigmented skin who doesn’t use sunscreen.’
Sunscreen use also tends to encourage prolonged sun exposure.
‘Sunscreen allows some UV radiation through. If people are using sunscreen to avoid getting sunburnt, their skin will still receive some UV radiation. And even small doses of radiation can cause harm for people with pale skin,’ she said.
‘Importantly, we have definitive evidence from randomised controlled trials (which overcome the problems of the observational studies) that regularly using sunscreen reduces the risk of skin cancer.’
Myth: oxybenzone is a toxic hormone blocker
Oxybenzone, an active ingredient in chemical sunscreens, absorbs both UV-B and short-range UV-A rays.
But there have been concerns aired on social media that oxybenzone is in fact toxic, acting as a ‘hormone blocker’ or ‘endocrine disruptor’.
This may be particularly worrisome for women who are trying to conceive or during perinatal, perimenopausal or menopausal stages.
Yet these concerns are harder to dismiss, acknowledged Prof Neale.
‘Animal and in vitro studies show some evidence that sunscreen ingredients can affect cell behaviour,’ she said. ‘But the findings are inconsistent – some mouse studies show effects, while others don’t.’
However, the United States Food and Drug Administration (FDA) has conducted studies revealing that certain chemical sunscreen ingredients can be absorbed through the skin into the bloodstream at levels exceeding 0.5 ng/mL.
‘[This absorption occurs] at a level where the FDA has recommended that further investigation is warranted,’ said Prof Neale.
Yet, she emphasised that ‘this is not evidence of harm’.
‘The authors of that study recommend that people continue to use sunscreen because we know that sunscreen is beneficial, and there is no convincing evidence of harm,’ she said.
The Therapeutic Goods Administration regulates primary sunscreen products, and some secondary sunscreens, for use in Australia, which should provide users with confidence that the ingredients and formulations are safe and effective.
Myth: sunscreen reduces vitamin D levels
Yet another social media gripe is that sunscreen reduces vitamin D levels – which is important for musculoskeletal health and has been linked to autoimmune conditions such as multiple sclerosis.
While this claim is not entirely a myth, its significance is often overstated.
Given sunscreen works by blocking or absorbing UVB radiation, which is responsible for triggering vitamin D production in the skin, sunscreen should in theory lower vitamin D synthesis.
However, there is little evidence to suggest this occurs in real-life settings.
For those with very pale skin who are advised to limit sun exposure with clothing and sunscreen, there’s a way to both ensure vitamin D levels are maintained and reduce the risk of skin cancer.
‘Vitamin D supplements are a cheap and effective substitute for sun exposure as a way of maintaining adequate vitamin D status,’ added Prof Neale.
When in doubt, suggest a mineral alternative
For those concerned about chemical absorption, the FDA has classified two mineral sunscreen ingredients – zinc oxide and titanium dioxide – as ‘generally recognised as safe and effective’.
This could particularly assuage parents who are concerned about exposing young children to ingredients that are claimed to be toxic, said Prof Neal.
Mineral sunscreens come in a thicker texture and work immediately by reflecting UV rays. While non-irritating and suitable for sensitive skin, they can leave a white cast on the skin and are harder to blend.
Chemical sunscreens absorb UV rays, taking about 20 minutes before it starts working. While available in an easily blendable light weight texture, some formulations may irritate sensitive skin.
‘A while ago, there were concerns about nanoparticles in the mineral sunscreens, but that's been pretty thoroughly debunked.’
Given the mineral varieties work as a physical UV blocker, they won’t appeal to everyone.
‘They don't spread as easily or feel as nice on the skin,’ she said. ‘But kids probably don't mind as much about the feel of it.’
Leave judgement at the door
With pharmacists being key providers of sun protection advice, it’s important to take a non-judgmental approach when people express concerns about sunscreen – particularly when discussing use in young children.
But it’s important to emphasise that there is no convincing evidence that sunscreens cause harm, while there is strong evidence to suggest sunscreens are beneficial.
‘It's really important that pharmacists support people to continue using sunscreen and to find a sunscreen that works for them – while also recognising that sun protection does not just mean sunscreen,’ said Prof Neale.
‘They should support people to use the entire suite of sun protection measures, such as putting on clothing, avoiding activities during peak UV times if possible, wearing a broad-brimmed hat and seeking shade.’
Move past the myths, focus on the benefits
While it’s important to get the message across about sun safety, Prof Neale said conversations about potential harms of sunscreen shouldn’t be given too much oxygen.
‘We should not be talking about it as much as we have started to, because it's almost like giving people a license to worry about it,’ she said. ‘There is no doubt that the sun causes skin cancer, and we have an epidemic of it.’
Skin cancer on the face is quite common, and while a broad-brimmed hat provides a good level of protection, it doesn't prevent harm from reflected light off the ground.
‘It's really important we emphasise that regular sunscreen use can prevent this,’ said Prof Neale.
Talking about the benefits of sunscreen, rather than the harms, is the best way to dispel these myths.
This includes preventing photoaging and actinic keratosis – which may turn into skin cancer.
‘We spend a fortune on treating sunspots and the treatments can be painful and unpleasant,' she said.
‘One day, maybe we'll find out that there is some confirmed harm from sunscreen, but I'll be very surprised.’
[post_title] => Battling social media misinformation around sunscreen
[post_excerpt] => Sunscreen myths are thriving on social media. An expert explains the evidence-based recommendations to help pharmacists combat misinformation.
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[post_content] => Under a new government plan, pharmacists will be key to dramatically reducing HIV transmission.
Ahead of World AIDS Day (Sunday 1 December), the federal government released the Ninth National HIV Strategy (2024–2030) with the ambitious aim of eliminating HIV transmission by 2030.
Australia has achieved significant progress in reducing HIV transmission over the last decade, marked by a 33% decline in HIV notifications between 2014 and 2023.
Key to this success is increased rates of viral suppression among people living with HIV and the widespread uptake of pre-exposure prophylaxis (PrEP) among HIV-negative people, particularly among gay, bisexual, and other men who have sex with men.
Australia has also surpassed the Joint United Nations Programme on HIV/AIDS (UNAIDS) 2025 target of 86%, with 87% of all people living with HIV achieving viral suppression – reducing the risk of onward transmission to zero when there’s an undetectable viral load.
‘PSA is ready to work with government to investigate how pharmacists can be supported to increase HIV PrEP uptake to eligible people through pharmacist prescribing of PrEP, including long-acting injectables and oral formulations.'
a/prof FEI SIM FPS
‘In the 40 years since HIV/AIDS reached Australia, we have made remarkable progress,’ said Minister for Health and Aged Care Mark Butler. ‘This Strategy marks one of the final steps to achieving the virtual elimination of HIV transmission in Australia.’
We’ve come a long way
The first AIDS diagnosis in Australia occurred in 1982. But over the past four decades, Australia has experienced significant changes in HIV transmission rates.
Following the introduction of HIV testing in 1985, newly diagnosed HIV infections peaked at 2,773 cases in 1987. This dropped by 1,062 the following year and continued to decline to 833 in 1995.
By 1999, the number of new diagnoses had decreased significantly, largely due to the adoption of prevention practices such as safe sex and needle and syringe exchange programs. This downward trend continued into the 21st century, with 552 new HIV diagnoses reported in 2021, attributable to increased testing and widespread use of antiretroviral therapy.
Public perception has also shifted since the 1987 ‘Grim Reaper’ campaign, which aimed to raise awareness but instead instilled widespread fear, stigmatising affected communities.
Advancements in treatment transforming HIV into a manageable condition has led to a shift in public perception. But stigma remains an issue. In 2017, the Australian Survey of Social Attitudes revealed that 52% of the general public indicated they would still behave negatively towards people living with HIV.
Inequitable outcomes
Despite Australia’s successes, improvements in transmission rates have not been experienced across the board – with some populations and regions lagging in testing and PrEP uptake.
HIV diagnosis rates are disproportionately higher among individuals from culturally and linguistically diverse (CALD) backgrounds, with a 21.5% increase in HIV notifications over the past decade, with these patients often diagnosed late. Late diagnosis rates are particularly common among those born in Sub-Saharan Africa , Southeast Asia and Central/South America.
Among Aboriginal and Torres Strait Islander peoples, the HIV notification rate in 2022 was 3.2 per 100,000, compared to 2.2 per 100,000 in the non-Indigenous population.
What are the key aspects of the strategy?
The three key elements of the strategy include reducing new and late diagnoses, promoting understanding and support of U=U (Undetectable = Untransmittable), and implementing and sustaining models of service for intervention – particularly among priority populations.
How does the new national strategy compare to the previous one?
The Eighth National HIV Strategy (2018–2022) and Ninth National HIV Strategy share a commitment to reducing HIV transmission in Australia. But the goals and pathway to achieving this vary.
The Eighth Strategy aimed to meet UNAIDS 90-90-90 targets, focusing on increasing diagnosis, treatment, and viral suppression rates through prioritised expanded access to PrEP, post-exposure prophylaxis (PEP), and harm reduction programs. Addressing stigma and barriers to care for key populations, such as gay and bisexual men, sex workers, and Aboriginal and Torres Strait Islander peoples was also a key focus.
Key achievements under this strategy include allowing people living with HIV who are ineligible for Medicare to access free treatment through government-funded hospital pharmacies in 2023 and providing options for rapid HIV testing and self-test kits in pharmacies under updated Therapeutic Goods Administration regulations.
But the ninth iteration has pushed the envelope further towards virtually eradicating HIV transmission.
This strategy reflects advancements in treatment and prevention technologies, such as long-acting injectable antiretrovirals and expanded use of U=U.
With a higher proportion of men from CALD backgrounds and Aboriginal and Torres Strait Islander peoples acquiring HIV, the ninth strategy emphasises tailored approaches to improve access to care and ensure equitable treatment.
Multicultural organisations and Aboriginal Community Controlled Health Organisations are key to improving awareness of HIV in these communities. This includes design and delivery of culturally appropriate health promotion programs, delivery of peer-based services or directing patients to existing resources.
What’s the role of pharmacists?
Pharmacies are identified as a priority setting within the strategy as an important healthcare service used by priority populations to access HIV care, said a spokesperson for the Department of Health and Aged Care.
‘Pharmacists can play a key role in the virtual elimination of HIV transmission through the four key priorities of the strategy: prevention, testing, treatment and care, and stigma,’ said the spokesperson.
‘In partnership with the HIV sector, the Australian Government is investigating options to increase access to PrEP, including through pharmacists, as recommended by the HIV Taskforce and reflected in the new 9th National HIV Strategy.’
This includes options for promoting, prescribing or supplying PrEP through pharmacies, which is particularly vital among populations with limited access to healthcare services such as in rural or remote areas and CALD communities.
Simplifying PrEP regimen management, such as extending prescription cycles and monitoring requirements beyond 3 months and providing multiple pathology forms for repeat testing could encourage uptake.
However, at this time, there are no plans to change current access arrangements to post-exposure prophylaxis (PEP) for HIV, said the spokesperson.
[caption id="attachment_28347" align="alignnone" width="600"] PSA National President Associate Professor Fei Sim FPS[/caption]
While PSA shares the ambitious but achievable goal of the government’s updated national HIV strategy to virtually eliminate HIV transmission in Australia by 2030, PSA National President Associate Professor Fei Sim FPS said we can go further in utilising the skills and expertise of pharmacists to reduce barriers to care for people living with or at risk of HIV.
‘[This includes] making medications like PrEP and PEP more accessible to the communities who need them, increasing access to HIV testing and reducing stigma,’ she said.
‘PSA is ready to work with government to investigate how pharmacists can be supported to increase HIV PrEP uptake to eligible people through pharmacist prescribing of PrEP, including long-acting injectables and oral formulations.’
As new formulations come to the Australian market, such as long-acting injectable antiretroviral therapy, pharmacists can play an even greater role in supporting patients at risk of HIV, including both medicine administration and point of care testing.
‘To deliver on the goals of our HIV strategy, all health professionals, including pharmacists, need to do more to combat stigma,’ said A/Prof Sim. ‘This includes increasing awareness and understanding of U=U in the general population and supporting health workers to provide accessible, non-judgmental, and evidence-based care.’
[post_title] => Pharmacists could prescribe PrEP to combat HIV transmission
[post_excerpt] => Under a new national government strategy, pharmacists will be key to dramatically reducing HIV transmission.
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[post_content] => The Therapeutic Goods Administration (TGA) has issued a Serious Scarcity Substitution Instruments (SSSI) to help pharmacists and patients manage the shortage of hormone replacement therapy (HRT) patches.
A global shortage of menopausal hormone therapies (MHT) has persisted throughout 2024, leaving many women 'unable to function’.
Around 13% (260,000) of Australian menopausal women take MHT. But with another 80,000 women estimated to have gone through menopause this year, demand is only set to increase.
But it's not only older women who benefit from using these patches. Younger women undergoing early menopause due to chemotherapy or conditions affecting the ovaries or pituitary gland need oestrogen. So do transgender women and non-binary individuals as part of feminising hormone therapy for gender affirmation.
With shortages of many of these medicines set to persist into 2025, the SSSI allows pharmacists to dispense an alternative brand or strengths to these patients, if appropriate, without a new prescription from the prescriber.
What HRT substitutions are available for patients?
A representative for Sandoz told Australian Pharmacist that the manufacturer is ‘committed to addressing the global supply challenges for MHT and HRT transdermal patches’.
‘In collaboration with the local authorities and global manufacturing partners, we have taken proactive steps to alleviate supply constraints,’ said the spokesperson.
‘Although Estradot (estradiol) registered products will have constrained supply throughout the first half of 2025, as noted on the TGA medicines shortages website, we are pleased to confirm alternative products have received Section 19A conditional approval for release in Australia.’
Medsurge Healthcare, which sources and supplies essential medicines in times of critical need and uncertainty, has also been able to arrange for the supply of alternative products on a temporary basis until the shortages of Australian registered medicines are resolved, a spokesperson for Medsurge told AP.
‘Medsurge was granted temporary S19A approval under section 19A of the Therapeutic Goods Act 1989 and has worked diligently to fill a critical need for patients,’ said the Medsurge spokesperson.
Under Section 19A, the following brands and strengths of HRT patches can be substituted for out-of-stock Estraderm MX and Estradot patches:
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[post_content] => These oft-used medicines have become the analgesia of choice for many prescribers. But care should be taken before prescribing gabapentinoids to certain patients.
Gabapentinoid medicines are widely prescribed in Australia. Considered a safer alternative to opioids for neuropathic pain, there was an 8-fold increase in prescriptions for gabapentinoids from 2012 to 2018 – with 1 in 7 Australians aged 80 and older prescribed a gabapentinoid.
[caption id="attachment_28316" align="aligncenter" width="1280"] Source – Pregabalin prescribing patterns in Australian general practice, 2012–2018: a cross-sectional study[/caption]
But a new study from Monash University researchers, including pharmacists Miriam Leung and Professor Simon Bell FPS, found that harm can be caused within 2 months of initiation.
Over a 5-year period, the researchers analysed data for 28,293 patients in Victoria who experienced hip fractures.
‘Our research found that patients who were recently dispensed either pregabalin or gabapentin had 30% higher odds of experiencing a hip fracture,’ Prof Bell told Australian Pharmacist.
Who is most at risk?
The link between gabapentinoid use and hip fractures existed across different age groups.
However, the risk of hip fracture associated with gabapentinoid medicines was highest in patients who were frail or had renal impairment, said Prof Bell.
‘Frail older people are prone to falls and fractures,’ he said. ‘One in 25 adults aged 80 years and older experience a hip fracture each year.’
The impact of these incidents can be fatal.
‘Around one in four people who experience a hip fracture die within 12 months,’ said Prof Bell.
How should pharmacists assess and manage falls risk?
For certain neuropathic pain conditions such as postherpetic neuralgia, diabetic neuropathy, and mixed or post-traumatic neuropathy, gabapentinoids such as pregabalin or gabapentin can provide effective relief.
However, while approved by the Australian Therapeutic Goods Administration for refractory focal (partial) epilepsy and neuropathic pain, gabapentin and pregabalin are often prescribed off label – with limited evidence to support efficacy for off-label indications.
In patients who are likely to see some benefit of therapy, pharmacists should advise patients how to minimise risk before dispensing these medicines.
‘The risk of falls is highest at the start of treatment,’ said Prof Bell.
‘Therefore, it’s important that pharmacists and other clinicians advise on strategies to minimise falls risk at this time. This could include avoidance of other falls-risk increasing substances such as alcohol.’
Evaluating what other medicines at-risk patients are prescribed is also an important strategy for preventing harm.
‘It’s known that gabapentinoids can cause side-effects such as drowsiness, sedation and dizziness,’ said Prof Bell.
‘These side-effects may increase the risk of falls, particularly if gabapentinoids are co-administrated with other psychotropic or cardiovascular falls risk medications.’
What impact can dose have on falls risk?
Given risk is highest at the outset of treatment, the starting dose of gabapentinoids can also have an impact on the likelihood of falls.
‘It’s advisable that patients start with a low dose and titrate slowly,’ said Prof Bell. ‘This particularly applies to people who are frail or have renal impairment.’
When is a discussion with the prescriber warranted?
The ongoing need for gabapentinoid treatment for neuropathic pain should be reviewed regularly, said Prof Bell.
‘If patients do not experience benefit after an adequate trial of treatment, then gradual discontinuation may be warranted,’ he said.
However, it’s important to advise people who take a gabapentinoid medicine that they shouldn’t stop taking their medication without first speaking with their prescriber or pharmacist first.
‘Stopping gabapentinoid medications abruptly can cause withdrawal symptoms,’ Prof Bell added.
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[post_content] => Missing the mark: why Australians are getting blood pressure checks wrong and what pharmacists can do to help.
More than one in three (34%) of Australian adults have high blood pressure. Of those diagnosed with hypertension, a staggering 68% have uncontrolled blood pressure.
Effectively managing hypertension is the most powerful method of lowering the risk of cardiovascular disease; reducing blood pressure by 5 mm Hg can decrease the probability of adverse cardiovascular events by 10%.
Yet new research found that most Australians don’t know how to measure their blood pressure accurately, nor are they getting advice on how to do so from healthcare professionals – including pharmacists.
Lead researcher Dr Niamh Chapman, Senior Research Fellow at the University of Sydney, explains where patients are getting it wrong, and the vital role pharmacists can play in blood pressure management.
Improper measurement methods are skewing results
While most patients knew they should be seated, have their back supported and remain silent during blood pressure measurement to ensure accurate readings, they weren't aware they should take multiple readings across different intervals conducted over several days.
‘They were doing it really frequently, (either) every week or every day,’ said Dr Chapman.
But the frequency of readings should depend on how they inform care. For example, if a patient needs a review of their blood pressure medications every 6 months, they could take their blood pressure at bi-annual intervals, following recommended steps, before visiting their GP for a script renewal, she said.
Table featured in the Conversation
When participants had a headache, felt unwell or were a bit stressed – this often served as a prompt for them to measure their blood pressure. However, all these factors can cause a variation in blood pressure results.
‘We know high blood pressure doesn't have any symptoms,’ said Dr Chapman. ‘To understand your risk of heart disease, stroke or dementia, that's not the best time to measure your blood pressure.’
Healthcare advice is lacking
Among people who measured their blood pressure at home, less than 20% received advice about how and when to do this from a doctor, nurse or pharmacist, said Dr Chapman.
The at-home devices patients used to measure their blood pressure were also not often clinically validated, which requires testing under an international protocol to assess the device’s reliability to deliver accurate blood pressure readings.
‘The [Therapeutic Goods Administration] only requires devices to be safe in terms of electrical safety, not [in accordance with] this rigorous accuracy testing,’ she said.
In further, as-yet-to-be-published research conducted by the University of Sydney, it was unearthed that most people buy blood pressure monitors from community pharmacists.
‘[But] only half of the devices that were purchased from pharmacies met this standard, and there's very little point-of-sale advice about what to do and what device to buy,’ said Dr Chapman.
Inaccurate readings could inform care decisions
Nearly 80% of people took often inaccurate at-home readings to their next doctor’s appointment. While not following the recommended steps is more likely to result in higher blood pressure readings, a tendency to opt for more favourable results was observed among respondents.
‘They were often taking lots of measurements, then trusting the lowest number, which was also a common [approach among] physicians,’ she said.
These readings were used to inform care decisions, such as confirming a diagnosis of hypertension or deciding whether to add or remove a medicine.
‘Often the home blood pressure measurements were valued by clinicians, because they can be performed more consistently and are more in-depth than one-off readings in a clinic,’ Dr Chapman added.
Pharmacists can improve the accuracy of blood pressure readings
As trusted healthcare providers, pharmacists have several opportunities to relay important messages to patients, said Dr Chapman.
‘Given most people buy their blood pressure device from pharmacies, it’s a great opportunity to provide basic training about how to use it, how to fit the cuff properly, what steps to follow, and when to take action,’ she said.
‘They can also provide education when people are refilling scripts for anti-hypertensive medications.’
First and foremost, pharmacists should advise patients to obtain a validated device according to national and international clinical guidelines, said Dr Chapman. This online tool can be used to check the validation status of blood pressure monitors.
From there, pharmacists should explain how to take a structured approach to at-home blood pressure readings. For example, this could entail taking blood pressure readings once a month, over 3–5 days in the morning and evening, she said.
‘The person should be seated, have 5 minutes rest and take two readings each time they measure their blood pressure, using the average of those.’
This BP Toolkit helps patients take and record their blood pressure averages in a way that's easy for their doctor to digest.
‘To simplify things for both patients and doctors, we created a 10-steps guide for measuring blood pressure, with a report [format] that makes it easier to understand what number to use to inform care,’ said Dr Chapman.
An even bigger role is in the works for pharmacists
As part of the National Hypertension Taskforce to improve blood pressure control, a big part of Dr Chapman’s focus is working with pharmacists to take a team-based approach to hypertension management.
This includes conducting a randomised controlled trial in 2025, in collaboration with PSA, to test the 'BP Toolkit’ – an educational support package designed to improve blood pressure control.
When patients visit the pharmacy for their blood pressure medication, they will be screened and offered a blood pressure check. Those in the intervention group will receive a counselling session with a pharmacist, covering medication adherence, lifestyle changes, action planning, and goal setting.
‘We'll look at delivering formal patient education and counseling, perhaps as part of a MedsCheck, to help improve blood pressure control,’ she said.
‘The goal is to deliver education that supports the patient to know whether or not they should go back to their doctor, and if they do go back to the doctor, what they should talk about.’
Dr Chapman is hoping to develop concrete evidence of the value pharmacists add to chronic disease management.
‘We will be [funding] the pharmacy sites for undertaking the blood pressure measurement and providing an additional payment for delivering the education to the intervention group,’ she said.
‘With that information, we want to demonstrate a fundable model to deliver this [service] that mirrors what happens with [Medicare Benefits Schedule] and [Pharmaceutical Benefits Scheme] items.’
Evidence shows that team-based care involving pharmacists can significantly improve blood pressure control.
‘What we now need to do is demonstrate what an appropriate fee-for-service model is and how this is sustainable and scalable within the context of Australia at a national level,’ said Dr Chapman.
Working closely with local consumer advisors on this research, a key takeout for Dr Chapman is the peace of mind one patient, a stroke survivor, was able to achieve after following recommended at-home blood pressure measurement guidelines.
‘The [relief] they got from measuring their blood pressure in a structured way once a month, instead of every day where it jumps around and they don’t know what the numbers mean, is the most valuable thing as a stroke survivor – allowing them to relax and know that their blood pressure is under control and they're reducing their risk of stroke,’ she said.
[post_title] => The real risks of wrong blood pressure readings
[post_excerpt] => Missing the mark: why Australians are getting blood pressure readings wrong and what pharmacists can do to help.
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[post_content] => Claims about sunscreen’s dangers are targeting young people, and while pharmacists know evidence shows them to be safe and effective, many in the Australian community do not.
The anti-sunscreen movement has picked up speed this year, thanks to the spread of misinformation by influencers on TikTok and other social media platforms. Popular podcasters Joe Rogan and Kristin Cavallari have also led discussions making misleading claims about risks of sunscreen.
Myths about sunscreen’s dangers are fueled by a broader decline of trust in science, said Professor Rachel Neale, Senior Group Leader at the QIMR Berghofer Medical Research Institute.
[caption id="attachment_25005" align="alignright" width="276"] Rachel Neale from the QIMR Berghofer Medical Research Institute[/caption]
‘People who are good at influencing others are getting their message through because of this loss of trust in authority and science,’ she said.
While this distrust predates COVID-19, the pandemic accelerated skepticism – particularly around the mass rollout of an ‘untested’ vaccine.
‘We're [also] seeing it in things such as the debate about fluoride in the US,’ she added.
While the fears around sunscreen lack concrete evidence, they are often based on a grain of truth albeit taken out of context.
Prof Neale walks through the key myths that are doing the rounds, and how pharmacists can help to debunk them.
Myth: sunscreen causes skin cancer
One prevailing theory circulating on social media is that sunscreen itself causes skin cancer.
‘In observational studies, people are asked “how often do you use sunscreen?”,’ she said. ‘And people who say they use sunscreen more are at higher risk of skin cancer.’
But there are a few important caveats about regular sunscreen users that give these findings context.
‘Sunscreen users are often paler and burn more easily,’ said Prof Neale.
‘People with very pale skin wearing sunscreen are still at higher risk than someone with more deeply pigmented skin who doesn’t use sunscreen.’
Sunscreen use also tends to encourage prolonged sun exposure.
‘Sunscreen allows some UV radiation through. If people are using sunscreen to avoid getting sunburnt, their skin will still receive some UV radiation. And even small doses of radiation can cause harm for people with pale skin,’ she said.
‘Importantly, we have definitive evidence from randomised controlled trials (which overcome the problems of the observational studies) that regularly using sunscreen reduces the risk of skin cancer.’
Myth: oxybenzone is a toxic hormone blocker
Oxybenzone, an active ingredient in chemical sunscreens, absorbs both UV-B and short-range UV-A rays.
But there have been concerns aired on social media that oxybenzone is in fact toxic, acting as a ‘hormone blocker’ or ‘endocrine disruptor’.
This may be particularly worrisome for women who are trying to conceive or during perinatal, perimenopausal or menopausal stages.
Yet these concerns are harder to dismiss, acknowledged Prof Neale.
‘Animal and in vitro studies show some evidence that sunscreen ingredients can affect cell behaviour,’ she said. ‘But the findings are inconsistent – some mouse studies show effects, while others don’t.’
However, the United States Food and Drug Administration (FDA) has conducted studies revealing that certain chemical sunscreen ingredients can be absorbed through the skin into the bloodstream at levels exceeding 0.5 ng/mL.
‘[This absorption occurs] at a level where the FDA has recommended that further investigation is warranted,’ said Prof Neale.
Yet, she emphasised that ‘this is not evidence of harm’.
‘The authors of that study recommend that people continue to use sunscreen because we know that sunscreen is beneficial, and there is no convincing evidence of harm,’ she said.
The Therapeutic Goods Administration regulates primary sunscreen products, and some secondary sunscreens, for use in Australia, which should provide users with confidence that the ingredients and formulations are safe and effective.
Myth: sunscreen reduces vitamin D levels
Yet another social media gripe is that sunscreen reduces vitamin D levels – which is important for musculoskeletal health and has been linked to autoimmune conditions such as multiple sclerosis.
While this claim is not entirely a myth, its significance is often overstated.
Given sunscreen works by blocking or absorbing UVB radiation, which is responsible for triggering vitamin D production in the skin, sunscreen should in theory lower vitamin D synthesis.
However, there is little evidence to suggest this occurs in real-life settings.
For those with very pale skin who are advised to limit sun exposure with clothing and sunscreen, there’s a way to both ensure vitamin D levels are maintained and reduce the risk of skin cancer.
‘Vitamin D supplements are a cheap and effective substitute for sun exposure as a way of maintaining adequate vitamin D status,’ added Prof Neale.
When in doubt, suggest a mineral alternative
For those concerned about chemical absorption, the FDA has classified two mineral sunscreen ingredients – zinc oxide and titanium dioxide – as ‘generally recognised as safe and effective’.
This could particularly assuage parents who are concerned about exposing young children to ingredients that are claimed to be toxic, said Prof Neal.
Mineral sunscreens come in a thicker texture and work immediately by reflecting UV rays. While non-irritating and suitable for sensitive skin, they can leave a white cast on the skin and are harder to blend.
Chemical sunscreens absorb UV rays, taking about 20 minutes before it starts working. While available in an easily blendable light weight texture, some formulations may irritate sensitive skin.
‘A while ago, there were concerns about nanoparticles in the mineral sunscreens, but that's been pretty thoroughly debunked.’
Given the mineral varieties work as a physical UV blocker, they won’t appeal to everyone.
‘They don't spread as easily or feel as nice on the skin,’ she said. ‘But kids probably don't mind as much about the feel of it.’
Leave judgement at the door
With pharmacists being key providers of sun protection advice, it’s important to take a non-judgmental approach when people express concerns about sunscreen – particularly when discussing use in young children.
But it’s important to emphasise that there is no convincing evidence that sunscreens cause harm, while there is strong evidence to suggest sunscreens are beneficial.
‘It's really important that pharmacists support people to continue using sunscreen and to find a sunscreen that works for them – while also recognising that sun protection does not just mean sunscreen,’ said Prof Neale.
‘They should support people to use the entire suite of sun protection measures, such as putting on clothing, avoiding activities during peak UV times if possible, wearing a broad-brimmed hat and seeking shade.’
Move past the myths, focus on the benefits
While it’s important to get the message across about sun safety, Prof Neale said conversations about potential harms of sunscreen shouldn’t be given too much oxygen.
‘We should not be talking about it as much as we have started to, because it's almost like giving people a license to worry about it,’ she said. ‘There is no doubt that the sun causes skin cancer, and we have an epidemic of it.’
Skin cancer on the face is quite common, and while a broad-brimmed hat provides a good level of protection, it doesn't prevent harm from reflected light off the ground.
‘It's really important we emphasise that regular sunscreen use can prevent this,’ said Prof Neale.
Talking about the benefits of sunscreen, rather than the harms, is the best way to dispel these myths.
This includes preventing photoaging and actinic keratosis – which may turn into skin cancer.
‘We spend a fortune on treating sunspots and the treatments can be painful and unpleasant,' she said.
‘One day, maybe we'll find out that there is some confirmed harm from sunscreen, but I'll be very surprised.’
[post_title] => Battling social media misinformation around sunscreen
[post_excerpt] => Sunscreen myths are thriving on social media. An expert explains the evidence-based recommendations to help pharmacists combat misinformation.
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[post_content] => Under a new government plan, pharmacists will be key to dramatically reducing HIV transmission.
Ahead of World AIDS Day (Sunday 1 December), the federal government released the Ninth National HIV Strategy (2024–2030) with the ambitious aim of eliminating HIV transmission by 2030.
Australia has achieved significant progress in reducing HIV transmission over the last decade, marked by a 33% decline in HIV notifications between 2014 and 2023.
Key to this success is increased rates of viral suppression among people living with HIV and the widespread uptake of pre-exposure prophylaxis (PrEP) among HIV-negative people, particularly among gay, bisexual, and other men who have sex with men.
Australia has also surpassed the Joint United Nations Programme on HIV/AIDS (UNAIDS) 2025 target of 86%, with 87% of all people living with HIV achieving viral suppression – reducing the risk of onward transmission to zero when there’s an undetectable viral load.
‘PSA is ready to work with government to investigate how pharmacists can be supported to increase HIV PrEP uptake to eligible people through pharmacist prescribing of PrEP, including long-acting injectables and oral formulations.'
a/prof FEI SIM FPS
‘In the 40 years since HIV/AIDS reached Australia, we have made remarkable progress,’ said Minister for Health and Aged Care Mark Butler. ‘This Strategy marks one of the final steps to achieving the virtual elimination of HIV transmission in Australia.’
We’ve come a long way
The first AIDS diagnosis in Australia occurred in 1982. But over the past four decades, Australia has experienced significant changes in HIV transmission rates.
Following the introduction of HIV testing in 1985, newly diagnosed HIV infections peaked at 2,773 cases in 1987. This dropped by 1,062 the following year and continued to decline to 833 in 1995.
By 1999, the number of new diagnoses had decreased significantly, largely due to the adoption of prevention practices such as safe sex and needle and syringe exchange programs. This downward trend continued into the 21st century, with 552 new HIV diagnoses reported in 2021, attributable to increased testing and widespread use of antiretroviral therapy.
Public perception has also shifted since the 1987 ‘Grim Reaper’ campaign, which aimed to raise awareness but instead instilled widespread fear, stigmatising affected communities.
Advancements in treatment transforming HIV into a manageable condition has led to a shift in public perception. But stigma remains an issue. In 2017, the Australian Survey of Social Attitudes revealed that 52% of the general public indicated they would still behave negatively towards people living with HIV.
Inequitable outcomes
Despite Australia’s successes, improvements in transmission rates have not been experienced across the board – with some populations and regions lagging in testing and PrEP uptake.
HIV diagnosis rates are disproportionately higher among individuals from culturally and linguistically diverse (CALD) backgrounds, with a 21.5% increase in HIV notifications over the past decade, with these patients often diagnosed late. Late diagnosis rates are particularly common among those born in Sub-Saharan Africa , Southeast Asia and Central/South America.
Among Aboriginal and Torres Strait Islander peoples, the HIV notification rate in 2022 was 3.2 per 100,000, compared to 2.2 per 100,000 in the non-Indigenous population.
What are the key aspects of the strategy?
The three key elements of the strategy include reducing new and late diagnoses, promoting understanding and support of U=U (Undetectable = Untransmittable), and implementing and sustaining models of service for intervention – particularly among priority populations.
How does the new national strategy compare to the previous one?
The Eighth National HIV Strategy (2018–2022) and Ninth National HIV Strategy share a commitment to reducing HIV transmission in Australia. But the goals and pathway to achieving this vary.
The Eighth Strategy aimed to meet UNAIDS 90-90-90 targets, focusing on increasing diagnosis, treatment, and viral suppression rates through prioritised expanded access to PrEP, post-exposure prophylaxis (PEP), and harm reduction programs. Addressing stigma and barriers to care for key populations, such as gay and bisexual men, sex workers, and Aboriginal and Torres Strait Islander peoples was also a key focus.
Key achievements under this strategy include allowing people living with HIV who are ineligible for Medicare to access free treatment through government-funded hospital pharmacies in 2023 and providing options for rapid HIV testing and self-test kits in pharmacies under updated Therapeutic Goods Administration regulations.
But the ninth iteration has pushed the envelope further towards virtually eradicating HIV transmission.
This strategy reflects advancements in treatment and prevention technologies, such as long-acting injectable antiretrovirals and expanded use of U=U.
With a higher proportion of men from CALD backgrounds and Aboriginal and Torres Strait Islander peoples acquiring HIV, the ninth strategy emphasises tailored approaches to improve access to care and ensure equitable treatment.
Multicultural organisations and Aboriginal Community Controlled Health Organisations are key to improving awareness of HIV in these communities. This includes design and delivery of culturally appropriate health promotion programs, delivery of peer-based services or directing patients to existing resources.
What’s the role of pharmacists?
Pharmacies are identified as a priority setting within the strategy as an important healthcare service used by priority populations to access HIV care, said a spokesperson for the Department of Health and Aged Care.
‘Pharmacists can play a key role in the virtual elimination of HIV transmission through the four key priorities of the strategy: prevention, testing, treatment and care, and stigma,’ said the spokesperson.
‘In partnership with the HIV sector, the Australian Government is investigating options to increase access to PrEP, including through pharmacists, as recommended by the HIV Taskforce and reflected in the new 9th National HIV Strategy.’
This includes options for promoting, prescribing or supplying PrEP through pharmacies, which is particularly vital among populations with limited access to healthcare services such as in rural or remote areas and CALD communities.
Simplifying PrEP regimen management, such as extending prescription cycles and monitoring requirements beyond 3 months and providing multiple pathology forms for repeat testing could encourage uptake.
However, at this time, there are no plans to change current access arrangements to post-exposure prophylaxis (PEP) for HIV, said the spokesperson.
[caption id="attachment_28347" align="alignnone" width="600"] PSA National President Associate Professor Fei Sim FPS[/caption]
While PSA shares the ambitious but achievable goal of the government’s updated national HIV strategy to virtually eliminate HIV transmission in Australia by 2030, PSA National President Associate Professor Fei Sim FPS said we can go further in utilising the skills and expertise of pharmacists to reduce barriers to care for people living with or at risk of HIV.
‘[This includes] making medications like PrEP and PEP more accessible to the communities who need them, increasing access to HIV testing and reducing stigma,’ she said.
‘PSA is ready to work with government to investigate how pharmacists can be supported to increase HIV PrEP uptake to eligible people through pharmacist prescribing of PrEP, including long-acting injectables and oral formulations.’
As new formulations come to the Australian market, such as long-acting injectable antiretroviral therapy, pharmacists can play an even greater role in supporting patients at risk of HIV, including both medicine administration and point of care testing.
‘To deliver on the goals of our HIV strategy, all health professionals, including pharmacists, need to do more to combat stigma,’ said A/Prof Sim. ‘This includes increasing awareness and understanding of U=U in the general population and supporting health workers to provide accessible, non-judgmental, and evidence-based care.’
[post_title] => Pharmacists could prescribe PrEP to combat HIV transmission
[post_excerpt] => Under a new national government strategy, pharmacists will be key to dramatically reducing HIV transmission.
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[post_content] => The Therapeutic Goods Administration (TGA) has issued a Serious Scarcity Substitution Instruments (SSSI) to help pharmacists and patients manage the shortage of hormone replacement therapy (HRT) patches.
A global shortage of menopausal hormone therapies (MHT) has persisted throughout 2024, leaving many women 'unable to function’.
Around 13% (260,000) of Australian menopausal women take MHT. But with another 80,000 women estimated to have gone through menopause this year, demand is only set to increase.
But it's not only older women who benefit from using these patches. Younger women undergoing early menopause due to chemotherapy or conditions affecting the ovaries or pituitary gland need oestrogen. So do transgender women and non-binary individuals as part of feminising hormone therapy for gender affirmation.
With shortages of many of these medicines set to persist into 2025, the SSSI allows pharmacists to dispense an alternative brand or strengths to these patients, if appropriate, without a new prescription from the prescriber.
What HRT substitutions are available for patients?
A representative for Sandoz told Australian Pharmacist that the manufacturer is ‘committed to addressing the global supply challenges for MHT and HRT transdermal patches’.
‘In collaboration with the local authorities and global manufacturing partners, we have taken proactive steps to alleviate supply constraints,’ said the spokesperson.
‘Although Estradot (estradiol) registered products will have constrained supply throughout the first half of 2025, as noted on the TGA medicines shortages website, we are pleased to confirm alternative products have received Section 19A conditional approval for release in Australia.’
Medsurge Healthcare, which sources and supplies essential medicines in times of critical need and uncertainty, has also been able to arrange for the supply of alternative products on a temporary basis until the shortages of Australian registered medicines are resolved, a spokesperson for Medsurge told AP.
‘Medsurge was granted temporary S19A approval under section 19A of the Therapeutic Goods Act 1989 and has worked diligently to fill a critical need for patients,’ said the Medsurge spokesperson.
Under Section 19A, the following brands and strengths of HRT patches can be substituted for out-of-stock Estraderm MX and Estradot patches:
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[post_content] => These oft-used medicines have become the analgesia of choice for many prescribers. But care should be taken before prescribing gabapentinoids to certain patients.
Gabapentinoid medicines are widely prescribed in Australia. Considered a safer alternative to opioids for neuropathic pain, there was an 8-fold increase in prescriptions for gabapentinoids from 2012 to 2018 – with 1 in 7 Australians aged 80 and older prescribed a gabapentinoid.
[caption id="attachment_28316" align="aligncenter" width="1280"] Source – Pregabalin prescribing patterns in Australian general practice, 2012–2018: a cross-sectional study[/caption]
But a new study from Monash University researchers, including pharmacists Miriam Leung and Professor Simon Bell FPS, found that harm can be caused within 2 months of initiation.
Over a 5-year period, the researchers analysed data for 28,293 patients in Victoria who experienced hip fractures.
‘Our research found that patients who were recently dispensed either pregabalin or gabapentin had 30% higher odds of experiencing a hip fracture,’ Prof Bell told Australian Pharmacist.
Who is most at risk?
The link between gabapentinoid use and hip fractures existed across different age groups.
However, the risk of hip fracture associated with gabapentinoid medicines was highest in patients who were frail or had renal impairment, said Prof Bell.
‘Frail older people are prone to falls and fractures,’ he said. ‘One in 25 adults aged 80 years and older experience a hip fracture each year.’
The impact of these incidents can be fatal.
‘Around one in four people who experience a hip fracture die within 12 months,’ said Prof Bell.
How should pharmacists assess and manage falls risk?
For certain neuropathic pain conditions such as postherpetic neuralgia, diabetic neuropathy, and mixed or post-traumatic neuropathy, gabapentinoids such as pregabalin or gabapentin can provide effective relief.
However, while approved by the Australian Therapeutic Goods Administration for refractory focal (partial) epilepsy and neuropathic pain, gabapentin and pregabalin are often prescribed off label – with limited evidence to support efficacy for off-label indications.
In patients who are likely to see some benefit of therapy, pharmacists should advise patients how to minimise risk before dispensing these medicines.
‘The risk of falls is highest at the start of treatment,’ said Prof Bell.
‘Therefore, it’s important that pharmacists and other clinicians advise on strategies to minimise falls risk at this time. This could include avoidance of other falls-risk increasing substances such as alcohol.’
Evaluating what other medicines at-risk patients are prescribed is also an important strategy for preventing harm.
‘It’s known that gabapentinoids can cause side-effects such as drowsiness, sedation and dizziness,’ said Prof Bell.
‘These side-effects may increase the risk of falls, particularly if gabapentinoids are co-administrated with other psychotropic or cardiovascular falls risk medications.’
What impact can dose have on falls risk?
Given risk is highest at the outset of treatment, the starting dose of gabapentinoids can also have an impact on the likelihood of falls.
‘It’s advisable that patients start with a low dose and titrate slowly,’ said Prof Bell. ‘This particularly applies to people who are frail or have renal impairment.’
When is a discussion with the prescriber warranted?
The ongoing need for gabapentinoid treatment for neuropathic pain should be reviewed regularly, said Prof Bell.
‘If patients do not experience benefit after an adequate trial of treatment, then gradual discontinuation may be warranted,’ he said.
However, it’s important to advise people who take a gabapentinoid medicine that they shouldn’t stop taking their medication without first speaking with their prescriber or pharmacist first.
‘Stopping gabapentinoid medications abruptly can cause withdrawal symptoms,’ Prof Bell added.
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Australian Pharmacist is the official journal for Pharmaceutical Society of Australia Ltd.
