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[post_content] => Tomorrow (Thursday 25 September 2025) is World Pharmacists Day – an annual milestone for the past 16 years that celebrates the pharmacy profession worldwide and amplifies its essential contribution to health systems.
The theme for this year’s World Pharmacists Day, as chosen by the International Pharmaceutical Federation (FIP) is ‘Think Health, Think Pharmacist’.
The theme reflects the vital role of pharmacists both in Australia and internationally, and the need to routinely embed them across all areas of the health system.
Ahead of the day, FIP President, Australia’s Paul Sinclair AM MPS said ‘Think Health, Think Pharmacist’ is more than a campaign – it’s a call to action.
‘Pharmacists are crucial to the safe use of medicines, chronic disease management and public health delivery. Investing in them is investing in stronger health systems,’ he said.
‘As the world faces rising healthcare demands, economic uncertainty, and growing threats like antimicrobial resistance and climate change – pharmacists remain key to ensuring safe, cost-effective, and accessible care.
‘From improving health literacy and delivering vaccinations to ensuring the safe use of medicines, pharmacists are an indispensable part of our health systems, especially in underserved communities.’
Getting involved in World Pharmacists Day
Australian pharmacists can get involved by engaging patients, politicians and stakeholders in conversation. Pharmacists can also champion the profession through social media, including:
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[post_content] => As US regulators flag new warnings, the Therapeutic Goods Administration (TGA) and Australian experts have weighed in on what the evidence shows.
Paracetamol has widely been considered the safest analgesic to relieve fever and pain during pregnancy. Fever higher than 38.9°C for at least 24 hours during pregnancy is linked to higher chances of miscarriage, preterm birth, stillbirth and certain malformations including neural tube defects like spina bifida.
Yet the US Food and Drug Administration (FDA) announced it intends to add a warning label to the medicine, citing a ‘possible association’ between autism in children and the use of acetaminophen (paracetamol) during pregnancy.
This proposed regulation change, along with updated advice given to the American Academy of Pediatrics among other medical groups, follows an announcement from the US President linking acetaminophen (Tylenol) (known as paracetamol in Australia) to autism – calling on pregnant women to avoid it.
Australia’s Chief Medical Officer Micahel Kidd has rejected claims about the use of paracetamol in pregnancy and the risk of developing ADHD or autism. So what are other experts saying?
TGA: ‘safe for use in pregnancy’
Paracetamol remains Pregnancy Category A in Australia, meaning that it is considered safe for use in pregnancy, a spokesperson for the TGA told Australian Pharmacist.
‘The use of medications in pregnancy is subject to clinical, scientific and toxicological evaluation at the time of registration of a medicine in Australia,’ the spokesperson said.
‘Paracetamol has been taken by a large number of pregnant women and women of childbearing age without any proven increase in the frequency of malformations or other harmful effects on the fetus having been observed.’
Paracetamol is still the recommended treatment option for pain or fever in pregnant women when used as directed, the TGA said.
‘Importantly, untreated fever and pain can pose risks to the unborn baby, highlighting the importance of managing these symptoms with recommended treatment.
The spokesperson said that the TGA maintains robust post-market safety surveillance and pharmacovigilance processes for all medicines registered in Australia, including paracetamol.
‘When safety signals are identified for a medicine, they are subject to detailed clinical and scientific investigation to confirm that a safety issue exists, and if confirmed, what regulatory actions are most appropriate to mitigate the risk,’ the spokesperson said. ‘The TGA has no current active safety investigations for paracetamol and autism, or paracetamol and neurodevelopmental disorders more broadly.’
Australia is not the only nation holding firm; international peer regulators, such as the UK Medicines and Healthcare products Regulatory Agency, continue to advise that paracetamol be used according to the approved Product Information.
In its 2019 review, the European Medicines Agency also determined that the available evidence on paracetamol’s effects on childhood neurodevelopment is inconclusive.
Is there any evidence linking paracetamol in pregnancy with autism?
Some systematic reviews have reported associations between paracetamol use in pregnancy and autism in children – usually prolonged, high-dose use that exceeds recommendations.
Of central interest to the US Government's claim is a 2025 systematic review which made the claim of ‘strong evidence of a relationship between prenatal acetaminophen use and increased risk of ASD in children’.
But the quality of these studies have been subject to significant critical review.
Professor Margie Danchin, a paediatrician and group leader of the Murdoch Children’s Research Institute’s Vaccine Uptake Group, refuted the evidence base, made up of observational studies, linking paracetamol to autism.
‘The cause of fever for the women in those studies is probably what caused the problems later on developmentally for the children, not the fact that they took Panadol for that fever.’
Additionally, Prof Danchin said many of the women who participated in these studies were asked several years postpartum whether they took paracetamol during pregnancy, further undermining accuracy.
More recent and robust studies contradict these claims and support the prevailing evidence that paracetamol is not causally linked to autism or ADHD, the TGA said.
Experts point to a Swedish cohort study as the most persuasive evidence on paracetamol and autism. Published last year, it analysed records for nearly 2.5 million children born between 1995 and 2019, identifying autism diagnoses and verifying whether mothers used paracetamol during pregnancy.
Crucially, the investigators conducted a sibling-comparison analysis, assessing pairs in which one child was prenatally exposed to paracetamol and the other was not. Because siblings share much of their genetics, household environment and maternal health influences, this approach helps isolate the impact of specific factors such as paracetamol.
In the largest study of its kind to date, no association was found between prenatal paracetamol exposure and autism.
Imparting safe and accurate information
Prof Danchin called the claim linking acetaminophen exposure in utero to autism ‘disinformation’.
‘At the moment, the biggest issue at play is trust,’ she said.
The danger of ‘repeatedly repeating myths’ is that it further entrenches them.
‘That sort of repetition becomes very sticky. People hear it all the time, and it becomes harder and harder to counter,’ Prof Danchin said.
However, health professionals should ensure the right messages get across, she said.
When counselling patients on paracetamol use in pregnancy, PSA has advised pharmacists to take the following approach:
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[post_content] => A new report lays bare the impact of chronic pain in young people. During Kids in Pain Week (22–28 September), an expert shares practical steps for pharmacists to improve care.
Sydney-based Laura was just 10 years old when a bout of shingles left her with constant, debilitating pain. Laura went from being a fit and active middle sister to being unable to walk or move without a wheelchair at the age of 11, and completely reliant on her family for care. Doctors were stumped and investigations proved fruitless.
‘I was so sick of doctors – waiting for the doctors and waiting to do anything and just so ready to give up,’ Laura said.
[caption id="attachment_30566" align="aligncenter" width="500"]
Laura with her mum Michelle[/caption]
When living with chronic pain, it’s easy to feel misunderstood and lonely, she shared.
‘Laura was having a really hard time, was depressed, barely talking and struggling. It was so hard to see her like that,’ Laura’s mum, Michelle said.
‘People underestimate how chronic pain may start as a physical issue but then becomes a mental health issue when everything is so uncertain and you aren’t sure if life will ever be what it was.’
Around one in five children aged 6–18 live with chronic pain, which equates to approximately 877,000 Australian kids – according to Australian Bureau of Statistics (ABS) data.
The inaugural Kids in Pain Report from Chronic Pain Australia shows how pain affects every aspect of these children’s lives, as well as their families, and the many who are likely unaccounted for, said pharmacist and Chronic Pain Australia chairperson, Nicolette Ellis MPS.
‘In 2019 the World Health Organization recommended that chronic pain be recognised as a condition in its own right and provided a way to capture that in healthcare data with ICD-11 coding,’ she said. ‘But chronic pain isn’t recognised as a condition in Australia; it’s recognised only as a symptom of an injury or another condition.’
[caption id="attachment_30564" align="aligncenter" width="500"]
Nicolette Ellis MPS[/caption]
Without robust prevalence data, chronic pain will remain missing from national policy – including the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme, Ms Ellis warned.
‘That cascades down into service planning and investment, which is not currently matched to need,’ she said. ‘For example, Australia only has nine specialist paediatric pain clinics; Tasmania and the Northern Territory have none, so families often travel 4–6 hours for specialist appointments.’
What does chronic pain look like in children?
Most (71%) of children experience musculoskeletal pain, typically due to rheumatoid arthritis and autoimmune conditions as well as lower-back pain, knee pain and other joint pain. Migraine and headaches, abdominal pain, connective-tissue disorders, neuropathic pain and pelvic pain are also prominent.
‘Most children have overlapping conditions – for example, migraine with abdominal pain, or musculoskeletal and neuropathic pain – so it’s rarely a single tidy diagnosis,’ Ms Ellis said.
There is a high correlation between neurodivergence and pain, with almost three-quarters (72.9%) of children with chronic pain having at least one neurodivergent diagnosis.
‘Life can be more stressful for neurodivergent individuals, producing hormones that amplify pain signals,’ she said.
About 60% of children with chronic pain also identified as female.
‘Women and girls have denser nerve networks and different immune systems,’ Ms Ellis said. ‘Fluctuations in oestrogen can also increase pain signals, while testosterone tends to reduce them.’
Why is there such a long road to diagnosis?
For over 64% of children living with chronic pain, it took at least 3 years to receive a diagnosis.
‘Culturally, there’s a belief that persistent pain is an “older person’s condition”,’ Ms Ellis said. ‘So many children’s pain is dismissed.’
It’s often assumed there is another reason driving the symptoms.
‘Common explanations given to families are anxiety, a mental-health issue, “growing pains” that will resolve, or school avoidance,’ she said. ‘That invalidates the child and parent, and delays diagnosis.’
Children can face significant challenges navigating the healthcare system, getting answers, and accessing quality treatment, leading to cascading consequences.
‘Around 80% of children have a secondary mental health challenge, report sleep issues and forgo sport and similar activities,’ she said. ‘Over 80% miss school, about 1 day per week on average, with many finding the school system inflexible and invalidating, with pain dismissed or labelled as avoidance.’
Should a child experience ongoing, persistent pain, it should be taken ‘very seriously’ by health professionals – including pharmacists – with early intervention and thorough assessment ideally taking place within the first 3–6 months.
‘Early action reduces chronicity, helps build tools and confidence in self-management, and helps keep children in school and engaged socially,’ Ms Ellis said.
What’s the pharmacist’s role?
Parents reported that they often see their pharmacist first to discuss their child's pain condition. To expedite diagnosis and ensure appropriate care, Chronic Pain Australia has released a Pharmacist Guide which includes language tips for discussing pain with children, ways to explain pain, and what good pain management looks like.
‘Pharmacists should ask how long the pain has been present and validate that it’s challenging to live with,’ Ms Ellis said. ‘Emphasise the importance of seeing a local GP for assessment and early diagnosis.’
Other key language tips include using ‘lives with pain’ over ‘suffers from’. Pharmacists should also describe ‘bad” or ‘challenging’ days rather than ‘flare-ups’.
‘Link with local providers, such as occupational therapists, physiotherapists and psychologists – who understand different communication and treatment needs, including for neurodivergent children who may express pain differently,’ she said.
When addressing children with neurodivergence, pharmacists should inquire how best to communicate with them, what topics to avoid and what information would help.
‘Communication should always be age-appropriate and family-centred,’ Ms Ellis said. ‘The goal is to create a friendly, approachable environment where children feel comfortable sharing, while parents can help fill in the picture when needed.’
How should symptom management be approached?
Management approaches for chronic pain depend on the child, condition, and whether function improves, Ms Ellis said.
‘In paediatric pain medicine we try to avoid medicines and use them sparingly, but if a non-functional child becomes functional on a medicine that may restore quality of life – that should be central to pain management.’
Ms Ellis recalls an example of a 14-year-old girl prescribed an opioid to be taken before menstruation for 4–5 days. While some healthcare professionals were quick to label this approach an addiction risk, it perhaps kept her in school during severe periods while investigations took place for endometriosis or polycystic ovarian syndrome.
‘Pharmacists concerned about higher-risk medicines should focus conversations on functional benefit, asking “Is this improving your ability to do things?”’ she said. ‘If not, initiate a discussion about whether to continue therapy, given the potential harms.’
With her mum’s support and extensive physical therapies, Laura was able to walk into her first day of high school without a walking stick. While she has good and bad days and constant flare ups, there are wins along the way – such as being able to start carrying a backpack rather than relying on a roller case.
‘It’s an invisible disability with constant pain that isn’t linear – there are different levels and sensations all the time and that changes the way I approach daily life,’ Laura said.
‘[But] when mum said I will keep fighting for you – it was almost like a promise, and she’s always kept it.’
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[post_content] => The various dementias are a huge cause of death in Australia. Despite some light on the horizon, there are still no effective treatments. AP explores the latest in dementia research.
Dementia is the second leading cause of death in Australia.1 The number of people living with the disease is expected to increase substantially as the population ages, potentially straining health systems.2
Despite accelerated research, including trials of more advanced compounds and recent Victorian Government grants supporting mRNA-based projects, effective treatments remain elusive.3
According to Dementia Australia's Executive Director of Services, Advocacy and Research, Dr Kaele Stokes (she/her), an estimated 433,000 Australians are currently living with dementia, including 29,000 people living with younger-onset dementia (when symptoms emerge before age 65).1
While there have been important advances in pharmaceutical research in the dementia field in recent years, Dr Stokes says, new medicines to date have limited application, availability and efficacy, and they do not stop the progression of dementia.
It is important to ensure health systems support everyone living with dementia now, she adds, noting that the new medicines may not work for many people with the condition, particularly patients who have lived with dementia for some time.
‘We don’t have an approach here in Australia that focuses on the importance of brain health across the life course,’ she says.
‘While we’re good at picking up other diseases, such as cardiovascular disease or diabetes, and putting steps in place to ensure the risks of severity in those conditions are minimised, we don’t really have conversations about brain health in a healthcare setting.’
Diagnosing dementia for younger and older people
Dr Stokes says while diagnostic tools are improving, diagnosing dementia is still a complex process.
Dementia is still seen as an older person’s disease, she adds, and it can be difficult for a person in their 40s or 50s to receive a dementia diagnosis.
According to a 2025 study in Translational Psychiatry, young-onset dementia in people aged under 65 years globally increased substantially in prevalence and incidence between 1990 and 2021 compared with overall people with dementia – and with a higher burden on women.4 The three highest risk factors were smoking, high body mass index and high fasting plasma glucose levels, while population growth was the largest contributor to the significant increase.4
‘There’s still a real fear and stigma around wanting to talk about brain health or talking to a healthcare professional about concerns around changes in cognition,’ Dr Stokes says.
‘But actually there are lots of reasons why it’s important to do that. A mix of pharmacological and non-pharmacological interventions can make a difference to quality of life and reduce the stress that somebody might be experiencing.’
It is important for people to focus on modifiable risk factors, potentially reducing the risk of developing dementia by about 45% by avoiding smoking or drinking too much and by maintaining a healthy diet, exercising regulary, and ensuring hearing and vision problems are identified and dealt with, Dr Stokes says.
For those at later stages of their lives, it’s important to avoid social isolation and to keep the brain active, she adds.
‘Learning new things can be really important – stretching the brain, firing up the neurons, to keep your brain active.’
Pharmacological advances
Healthcare professionals have high hopes for the potential benefits of newly available monoclonal antibody treatments for Alzheimer’s disease.5
University of Melbourne and Florey Institute Professor of Dementia Research Colin Masters, widely recognised as a world expert in the field of neurodegenerative diseases, estimates there are about 100 compounds in the pharmaceutical pipeline presently that are progressing through the trial stages.
‘Better forms, more effective forms, are coming within the next couple of years,’ he declares. ‘We’ve got to learn how to use them and manage all the adverse effects as well.’ He is optimistic about the future of dementia treatments – potentially including a routine vaccination.
‘The writing is on the wall,’ he says. ‘If the passive immunotherapies work, then everyone will be working on an active vaccination program. In other words, at age 50 or whatever, you just run up to your primary care physician, they do a blood test, you’re on the pathway – you get a shot of peptide in your arm.’
The most promising drug now on the horizon is trontinemab, Prof Masters says. It's a reinvented form of the monoclonal antibody gantenerumab – a drug that didn’t make it to market because of a lack of efficacy. Even so, he adds, gantenerumab has been found effective for certain conditions. ‘We’ve been trialling it for nearly 10 years now,’ Prof Masters says, ‘and we published in Lancet Neurology9 [in June 2025] that in early-onset familial types of Alzheimer’s disease, gantenerumab in high doses was effective in pre-clinical disease in young individuals who are at 100% risk of developing Alzheimer’s disease.’ Trontinemab, he adds, is the natural successor to gantenerumab.
In April, Roche announced the results of a phase II trial of trontinemab delivered via the “Brainshuttle” system, which found ‘rapid and deep, dose-dependent reduction of amyloid plaques in the brain’.10 At the same time, Roche announced it would begin a phase III trial of the drug later this year.10
‘It’s the next generation; it’s a major advance,’ Prof Masters says, explaining that the bispecific molecule of trontinemab is designed to go straight across the blood-brain barrier, so doses of the drug can be far smaller.
‘It’s the first antibody designed to do this, and a lot of companies are copying it right now, because it works so well.’
According to data released from the Roche trials, trontinemab causes far fewer and less severe adverse effects than gantenerumab, he points out.
Other promising Alzheimer’s disease treatments include the monoclonal antibody donanemab. It is marketed as Kisunla by Eli Lilly, and in May 2025 it was approved by the Therapeutic Goods Administration.11
Lecanemab, marketed as Leqembi, has not yet been approved in Australia, but Prof Masters says full results of a pre-clinical trial are expected by the end of 2027 and he and his colleagues expect a positive result.
All these monoclonal antibody drugs are most effective in the early stages of Alzheimer’s disease, so early diagnosis is critical.12 In July this year, the Victorian Government also announced more than $537,000 in grants to two Florey researchers for two Alzheimer’s research projects.
These are aimed at treating and preventing the disease with mRNA technology, which was developed during the pandemic for COVID-19 vaccines.13
Pharmacist dementia support in the community
PSA’s Dementia Support Pharmacist Project in South Australia is an innovative project and model of practice aimed at keeping people with dementia at home and in the community for longer.14
Two pharmacists are employed on the project. They job-share to support clients with dementia medication management needs, understanding and choices, says South Australia and Northern Territory PSA Manager Helen Stone FPS (she/her).
The pharmacists act as patient advocates, provide flexible care for patients with complex comorbidities, and work with other members of the care team, including GPs, community pharmacists, nursing and care workers and families, she adds. Initial appointments are held in the patient's home, preferably with follow-ups either personally, by telephone or collaboration application such as MS Teams. A report prepared by the pharmacist is shared with the patient and, with consent, to treating medical and care teams, which may recommend an action plan to change or deprescribe medicines. Education about medicine use in dementia is also provided to health professionals and community groups across regional areas of the state.
‘This is a much-needed service; it is accessible, but there are a lot more people we can’t yet support,’ Ms Stone says. PSA has demonstrated that pharmacists working directly with patients and liaising with the care team can provide valuable support for patients with complex conditions and multimorbidities.
The project began in May 2024 and has been extended to June 2026. Ms Stone recently submitted a proposal to SA Health to expand the program and include a further five FTE pharmacists to cover metropolitan Adelaide.
Dementia care pharmacists can help with complex deprescribing of medicines and tapering of antidepressants where needed. They can provide professional advice to family members caring for patients with dementia that can empower carers as advocates in cases, for instance, of inadequate pain management.
Medicine administration frustrations can be avoided when dose time changes can be suggested.
Project pharmacist Dee-Anne Hull MPS (she/her) says pharmacist dementia support work helps in areas where it is needed most. ‘It has shown us where gaps in health care are in rural and remote areas of our state, but also within the pharmacy profession itself,’ she says. ‘A lot of pharmacists openly admit that dementia scares them, and they don’t really know where to start.
‘My advice is to make this an area of focus for CPD activities; check out the numerous PSA resources available, particularly those on palliative care and deprescribing, but also check out websites like Dementia Australia, Dementia Training Australia and the Wicking Dementia Centre,’ she adds.
‘Think about ways that you could support someone who is caring for a person living with dementia and the carer’s burden that may be associated with this, because that’s often where the support is needed the most.’
Positive response
Dementia Support Pharmacist Project pharmacist Nicola Sander MPS (she/her) says she has seen ‘overwhelming support and positive feedback’ for the project.
‘We have seen considerable benefit for people who are still living at home and are trying to manage their medicines.
Ms Sander sees this dementia support career pathway as ideal for an early career pharmacist and suggests that training in deprescribing and dementia-specific areas would be useful.
After a lengthy consultation with one client living at home, the client’s family and her doctor, Ms Sander recommended medicine management changes. The doctor was reluctant, so the client’s daughter found a doctor who was willing to be part of a multidisciplinary team, Ms Sander says, which included deprescribing strategies and pain support management.
After a recent visit to the geriatrician, the client’s daughter reported that her mother’s Mini‐Mental State Examination had improved from 12/30 to 19/30.
The daughter and the geriatrician attributed the client’s improvement to ‘better control of pain and overall improvement to her mood, as she has felt more supported and less depressed' since.
Ms Stone, whose Churchill Fellowship palliative care research – To articulate a framework for the role of Palliative Care Pharmacist in community and aged care in Australia – Churchill Trust15 – informed the Dementia Support Pharmacist Project, says that education, training and curiosity help pharmacists to start understanding dementia care more fully.
She encourages everyone to complete a Program of Experience in the Palliative Approach (PEPA) placement.
‘A dementia diagnosis can be devastating for people and their families; medications can have a benefit but can also impair cognition, so support from a pharmacist can be very valuable.'
References
- Australian Institute of Health and Welfare. Dementia In Australia. 2024. At: www.aihw.gov.au/reports/dementia/dementia-in-aus/contents/population-health-impacts-of-dementia/deaths-due-to-dementia
- Dementia Australia. Dementia facts and figures. 2024. At: www.dementia.org.au/about-dementia/dementia-facts-and-figures
- Florey Institute for Neuroscience and Mental Health. Harnessing mRNA to prevent and slow Alzheimer’s disease. 2025. At: https://florey.edu.au/news/2025/07/harnessing-mrna-to-prevent-and-slow-alzheimers-disease/
- He Q, Wang W, Zhang Y, et al. Global burden of young-onset dementia, from 1990 to 2021: an age-period-cohort analysis from the global burden of disease study 2021. Transl Psychiatry 2025. Epub 2025, 17 February.
- Ramanan VK, Armstrong MJ, Choudhury P, et al. Antiamyloid monoclonal antibody therapy for Alzheimer disease. Neurology 2023;101(19)842–52. At: www.neurology.org/doi/10.1212/WNL.0000000000207757
- World Health Organization. Dementia. 2025. At: www.who.int/en/news-room/fact-sheets/detail/dementia
- Mayo Clinic. Alzheimer’s disease. 2025. At: www.mayoclinic.org/diseases-conditions/alzheimers-disease/symptoms-causes/syc-20350447
- Eyting M, Xie M, Michalik F, et al. A natural experiment on the effect of herpes zoster vaccination on dementia. Nature 2025. Epub 2025 2 April. At www.nature.com/articles/s41586-025-08800-x
- Safety and efficacy of long-term gantenerumab treatment in dominantly inherited Alzheimer's disease: an open-label extension of the phase 2/3 multicentre, randomised, double-blind, placebo-controlled platform DIAN-TU trial. Bateman, Randall J et al. Lancet Neurology 2025; 24(4):316–30.
- Roche. Roche presents novel therapeutic and diagnostic advancements in Alzheimer’s at AP/PD 2025. 2025. At: www.roche.com/media/releases/med-cor-2025-04-03
- Burge K. Treatment to slow early Alzheimer’s gets TGA approval. newsGP 2025. At: www1.racgp.org.au/newsgp/clinical/treatment-to-slow-early-alzheimer-s-gets-tga-appro
- Promising results of new Alzheimer’s drug published – early diagnosis is key. 2023. At: www.dementia.org.au/media-centre/media-releases/promising-results-new-alzheimers-drug-published-early-diagnosis-key
- Victoria State Government. mRNA Victoria. Research. July 2025. At: https://djsir.vic.gov.au/mrna-victoria/research
- Sander N, Jull DA. Bridging the gap: how dementia support pharmacists are transforming care in rural South Australia. Issue 91. June 2, 2025. At: https://ruralhealth.org.au/partyline/bridging-the-gap-how-dementia-support-pharmacists-are-transforming-care-in-rural-south-australia/
- Stone H. To articulate a framework for the role of the palliative care pharmacist in community and aged care in Australia. Winston Churchill Trust 2025. At: www.churchilltrust.com.au/project/to-articulate-a-framework-for-the-role-of-palliative-care-pharmacist-in-community-and-aged-care-in-australia/
[post_title] => Advancing dementia care in pharmacy
[post_excerpt] => The various dementias are a huge cause of death in Australia. Despite some light on the horizon, there are still no effective treatments.
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[post_content] => Pharmacists are asked to lead the shift from reliever-only inhalers to inhaled corticosteroid-containing regimens and to minimise short courses of oral corticosteroids.
Just under 3 million Australians live with asthma. The condition has the eighth-highest disease burden in the nation, and it is one of the most significant chronic conditions in children.
Guided by the results of large trials, recommendations for asthma management in adults and adolescents are changing, and pharmacists need to be aware of updated guidelines. The Australian Asthma Handbook was updated yesterday (16 September 2025) to reflect new thinking on asthma care and management.
What are the key updates?
Three key changes have been made to the Australian Asthma Handbook, including:
-
- All adults and adolescents with confirmed asthma should be taking inhaled corticosteroid-containing treatment and not as-needed short-acting beta2-agonists (SABAs) alone. Asthma can be well controlled with maintenance and reliever therapy, and a small proportion of patients with severe asthma may be eligible for biologics.
- An emphasis on the importance of limiting oral corticosteroids, which have been associated with a range of different harms, including damage to bone health, cataracts and type 2 diabetes.
- Health professionals should be aware the handbook has greater guidance for treating children aged 1–5 who are living with asthma and a recommendation that some older children should also be on low-dosage ICS maintenance therapy.
Why have the guidelines been updated?
Overuse of SABAs has been linked to poor asthma control and preventable hospitalisations.
‘The evidence is that the risks of SABA alone have become clearer and that we were overusing a not very effective and not very safe therapy,’ said Professor Nick Zwar, Executive Dean of Bond University’s Faculty of Health Sciences and Medicine, and Chair of the Australian Asthma Handbook Guidelines Committee.
‘Budesonide-formoterol, taken only as needed, is recommended in place of SABA. Maintenance and reliever therapy is now recommended as the next step up.’
The risks of SABA overuse include a lack of bronchodilator response over time, and the possibility that some people may have quite a severe asthma attack and end up in the hospital emergency department (ED), or hospitalised, when they don’t need to be.
There is very strong evidence to demonstrate that all adolescents and adults living with asthma should be treated with ICS, said pharmacist and Clinical Executive Lead at the National Asthma Council Australia, Debbie Rigby FPS.
‘Just having the SABA alone only treats one component of asthma, which is the bronchoconstriction, whereas having the low-dose ICS helps manage the inflammation and mucus production,’ she said. ‘I think that’s the biggest shift for us, pharmacists and doctors: helping patients to understand that asthma is a chronic inflammatory condition.’
What are the risks of poor asthma control?
Inadequately managed asthma can be a life-threatening condition, Ms Rigby stressed, noting there were 474 asthma-related deaths in Australia in 2023.
‘Those deaths shouldn’t be happening. Many of those people who did die from asthma or asthma-related causes would have been perceived as having mild, intermittent symptoms,’ she said. ‘Without wanting to scare patients, we should be really highlighting the consequences of not having good control of their asthma.’
Why is SABA still overused?
Despite access to long-acting beta2 agonists (ICS–LABAs), SABA use remains high for a range of reasons. These include cost, convenience and patient reluctance to medicate every day when they are accustomed to using a reliever-only when they have an asthma attack, Ms Rigby said.
Health professionals understand that many people are reluctant to use a preventer inhaler, but health professionals need to help them understand that they have a ‘chronic inflammatory condition, which may flare up from time to time’.
Effects of the cost-of-living crisis should not be underestimated either. However, the price gap between over-the-counter salbutamol and prescription asthma medicines is now narrowing, with 60-day dispensing for patients who are stable and, from January 2026, the co-payment for medicines being reduced from $31.60 to $25 per prescription.
The Australian uptake of Maintenance and Reliever Therapy (MART) has also been slow, despite strong evidence and subsidy on the Pharmaceutical Benefits Scheme. The evidence of large-scale trials has shown the importance of shifting patients with mild asthma onto anti-inflammatory reliever therapy on an as-needed basis, Ms Rigby said.
‘The evidence basically says it reduces the risk of severe exacerbations requiring ED or hospitalisation, or requiring oral corticosteroids,’ she said.
For practical guidance on discussing the guideline changes with patients, the role of prescribing pharmacists, and how biologics fit into care, don’t miss the October cover story in Australian Pharmacist.
[post_title] => New asthma guidelines released
[post_excerpt] => Pharmacists are asked to lead the shift from reliever to inhaled corticosteroid regimens and to minimise use of oral corticosteroids.
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[post_content] => Tomorrow (Thursday 25 September 2025) is World Pharmacists Day – an annual milestone for the past 16 years that celebrates the pharmacy profession worldwide and amplifies its essential contribution to health systems.
The theme for this year’s World Pharmacists Day, as chosen by the International Pharmaceutical Federation (FIP) is ‘Think Health, Think Pharmacist’.
The theme reflects the vital role of pharmacists both in Australia and internationally, and the need to routinely embed them across all areas of the health system.
Ahead of the day, FIP President, Australia’s Paul Sinclair AM MPS said ‘Think Health, Think Pharmacist’ is more than a campaign – it’s a call to action.
‘Pharmacists are crucial to the safe use of medicines, chronic disease management and public health delivery. Investing in them is investing in stronger health systems,’ he said.
‘As the world faces rising healthcare demands, economic uncertainty, and growing threats like antimicrobial resistance and climate change – pharmacists remain key to ensuring safe, cost-effective, and accessible care.
‘From improving health literacy and delivering vaccinations to ensuring the safe use of medicines, pharmacists are an indispensable part of our health systems, especially in underserved communities.’
Getting involved in World Pharmacists Day
Australian pharmacists can get involved by engaging patients, politicians and stakeholders in conversation. Pharmacists can also champion the profession through social media, including:
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[post_content] => As US regulators flag new warnings, the Therapeutic Goods Administration (TGA) and Australian experts have weighed in on what the evidence shows.
Paracetamol has widely been considered the safest analgesic to relieve fever and pain during pregnancy. Fever higher than 38.9°C for at least 24 hours during pregnancy is linked to higher chances of miscarriage, preterm birth, stillbirth and certain malformations including neural tube defects like spina bifida.
Yet the US Food and Drug Administration (FDA) announced it intends to add a warning label to the medicine, citing a ‘possible association’ between autism in children and the use of acetaminophen (paracetamol) during pregnancy.
This proposed regulation change, along with updated advice given to the American Academy of Pediatrics among other medical groups, follows an announcement from the US President linking acetaminophen (Tylenol) (known as paracetamol in Australia) to autism – calling on pregnant women to avoid it.
Australia’s Chief Medical Officer Micahel Kidd has rejected claims about the use of paracetamol in pregnancy and the risk of developing ADHD or autism. So what are other experts saying?
TGA: ‘safe for use in pregnancy’
Paracetamol remains Pregnancy Category A in Australia, meaning that it is considered safe for use in pregnancy, a spokesperson for the TGA told Australian Pharmacist.
‘The use of medications in pregnancy is subject to clinical, scientific and toxicological evaluation at the time of registration of a medicine in Australia,’ the spokesperson said.
‘Paracetamol has been taken by a large number of pregnant women and women of childbearing age without any proven increase in the frequency of malformations or other harmful effects on the fetus having been observed.’
Paracetamol is still the recommended treatment option for pain or fever in pregnant women when used as directed, the TGA said.
‘Importantly, untreated fever and pain can pose risks to the unborn baby, highlighting the importance of managing these symptoms with recommended treatment.
The spokesperson said that the TGA maintains robust post-market safety surveillance and pharmacovigilance processes for all medicines registered in Australia, including paracetamol.
‘When safety signals are identified for a medicine, they are subject to detailed clinical and scientific investigation to confirm that a safety issue exists, and if confirmed, what regulatory actions are most appropriate to mitigate the risk,’ the spokesperson said. ‘The TGA has no current active safety investigations for paracetamol and autism, or paracetamol and neurodevelopmental disorders more broadly.’
Australia is not the only nation holding firm; international peer regulators, such as the UK Medicines and Healthcare products Regulatory Agency, continue to advise that paracetamol be used according to the approved Product Information.
In its 2019 review, the European Medicines Agency also determined that the available evidence on paracetamol’s effects on childhood neurodevelopment is inconclusive.
Is there any evidence linking paracetamol in pregnancy with autism?
Some systematic reviews have reported associations between paracetamol use in pregnancy and autism in children – usually prolonged, high-dose use that exceeds recommendations.
Of central interest to the US Government's claim is a 2025 systematic review which made the claim of ‘strong evidence of a relationship between prenatal acetaminophen use and increased risk of ASD in children’.
But the quality of these studies have been subject to significant critical review.
Professor Margie Danchin, a paediatrician and group leader of the Murdoch Children’s Research Institute’s Vaccine Uptake Group, refuted the evidence base, made up of observational studies, linking paracetamol to autism.
‘The cause of fever for the women in those studies is probably what caused the problems later on developmentally for the children, not the fact that they took Panadol for that fever.’
Additionally, Prof Danchin said many of the women who participated in these studies were asked several years postpartum whether they took paracetamol during pregnancy, further undermining accuracy.
More recent and robust studies contradict these claims and support the prevailing evidence that paracetamol is not causally linked to autism or ADHD, the TGA said.
Experts point to a Swedish cohort study as the most persuasive evidence on paracetamol and autism. Published last year, it analysed records for nearly 2.5 million children born between 1995 and 2019, identifying autism diagnoses and verifying whether mothers used paracetamol during pregnancy.
Crucially, the investigators conducted a sibling-comparison analysis, assessing pairs in which one child was prenatally exposed to paracetamol and the other was not. Because siblings share much of their genetics, household environment and maternal health influences, this approach helps isolate the impact of specific factors such as paracetamol.
In the largest study of its kind to date, no association was found between prenatal paracetamol exposure and autism.
Imparting safe and accurate information
Prof Danchin called the claim linking acetaminophen exposure in utero to autism ‘disinformation’.
‘At the moment, the biggest issue at play is trust,’ she said.
The danger of ‘repeatedly repeating myths’ is that it further entrenches them.
‘That sort of repetition becomes very sticky. People hear it all the time, and it becomes harder and harder to counter,’ Prof Danchin said.
However, health professionals should ensure the right messages get across, she said.
When counselling patients on paracetamol use in pregnancy, PSA has advised pharmacists to take the following approach:
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[post_content] => A new report lays bare the impact of chronic pain in young people. During Kids in Pain Week (22–28 September), an expert shares practical steps for pharmacists to improve care.
Sydney-based Laura was just 10 years old when a bout of shingles left her with constant, debilitating pain. Laura went from being a fit and active middle sister to being unable to walk or move without a wheelchair at the age of 11, and completely reliant on her family for care. Doctors were stumped and investigations proved fruitless.
‘I was so sick of doctors – waiting for the doctors and waiting to do anything and just so ready to give up,’ Laura said.
[caption id="attachment_30566" align="aligncenter" width="500"] Laura with her mum Michelle[/caption]
When living with chronic pain, it’s easy to feel misunderstood and lonely, she shared.
‘Laura was having a really hard time, was depressed, barely talking and struggling. It was so hard to see her like that,’ Laura’s mum, Michelle said.
‘People underestimate how chronic pain may start as a physical issue but then becomes a mental health issue when everything is so uncertain and you aren’t sure if life will ever be what it was.’
Around one in five children aged 6–18 live with chronic pain, which equates to approximately 877,000 Australian kids – according to Australian Bureau of Statistics (ABS) data.
The inaugural Kids in Pain Report from Chronic Pain Australia shows how pain affects every aspect of these children’s lives, as well as their families, and the many who are likely unaccounted for, said pharmacist and Chronic Pain Australia chairperson, Nicolette Ellis MPS.
‘In 2019 the World Health Organization recommended that chronic pain be recognised as a condition in its own right and provided a way to capture that in healthcare data with ICD-11 coding,’ she said. ‘But chronic pain isn’t recognised as a condition in Australia; it’s recognised only as a symptom of an injury or another condition.’
[caption id="attachment_30564" align="aligncenter" width="500"] Nicolette Ellis MPS[/caption]
Without robust prevalence data, chronic pain will remain missing from national policy – including the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme, Ms Ellis warned.
‘That cascades down into service planning and investment, which is not currently matched to need,’ she said. ‘For example, Australia only has nine specialist paediatric pain clinics; Tasmania and the Northern Territory have none, so families often travel 4–6 hours for specialist appointments.’
What does chronic pain look like in children?
Most (71%) of children experience musculoskeletal pain, typically due to rheumatoid arthritis and autoimmune conditions as well as lower-back pain, knee pain and other joint pain. Migraine and headaches, abdominal pain, connective-tissue disorders, neuropathic pain and pelvic pain are also prominent.
‘Most children have overlapping conditions – for example, migraine with abdominal pain, or musculoskeletal and neuropathic pain – so it’s rarely a single tidy diagnosis,’ Ms Ellis said.
There is a high correlation between neurodivergence and pain, with almost three-quarters (72.9%) of children with chronic pain having at least one neurodivergent diagnosis.
‘Life can be more stressful for neurodivergent individuals, producing hormones that amplify pain signals,’ she said.
About 60% of children with chronic pain also identified as female.
‘Women and girls have denser nerve networks and different immune systems,’ Ms Ellis said. ‘Fluctuations in oestrogen can also increase pain signals, while testosterone tends to reduce them.’
Why is there such a long road to diagnosis?
For over 64% of children living with chronic pain, it took at least 3 years to receive a diagnosis.
‘Culturally, there’s a belief that persistent pain is an “older person’s condition”,’ Ms Ellis said. ‘So many children’s pain is dismissed.’
It’s often assumed there is another reason driving the symptoms.
‘Common explanations given to families are anxiety, a mental-health issue, “growing pains” that will resolve, or school avoidance,’ she said. ‘That invalidates the child and parent, and delays diagnosis.’
Children can face significant challenges navigating the healthcare system, getting answers, and accessing quality treatment, leading to cascading consequences.
‘Around 80% of children have a secondary mental health challenge, report sleep issues and forgo sport and similar activities,’ she said. ‘Over 80% miss school, about 1 day per week on average, with many finding the school system inflexible and invalidating, with pain dismissed or labelled as avoidance.’
Should a child experience ongoing, persistent pain, it should be taken ‘very seriously’ by health professionals – including pharmacists – with early intervention and thorough assessment ideally taking place within the first 3–6 months.
‘Early action reduces chronicity, helps build tools and confidence in self-management, and helps keep children in school and engaged socially,’ Ms Ellis said.
What’s the pharmacist’s role?
Parents reported that they often see their pharmacist first to discuss their child's pain condition. To expedite diagnosis and ensure appropriate care, Chronic Pain Australia has released a Pharmacist Guide which includes language tips for discussing pain with children, ways to explain pain, and what good pain management looks like.
‘Pharmacists should ask how long the pain has been present and validate that it’s challenging to live with,’ Ms Ellis said. ‘Emphasise the importance of seeing a local GP for assessment and early diagnosis.’
Other key language tips include using ‘lives with pain’ over ‘suffers from’. Pharmacists should also describe ‘bad” or ‘challenging’ days rather than ‘flare-ups’.
‘Link with local providers, such as occupational therapists, physiotherapists and psychologists – who understand different communication and treatment needs, including for neurodivergent children who may express pain differently,’ she said.
When addressing children with neurodivergence, pharmacists should inquire how best to communicate with them, what topics to avoid and what information would help.
‘Communication should always be age-appropriate and family-centred,’ Ms Ellis said. ‘The goal is to create a friendly, approachable environment where children feel comfortable sharing, while parents can help fill in the picture when needed.’
How should symptom management be approached?
Management approaches for chronic pain depend on the child, condition, and whether function improves, Ms Ellis said.
‘In paediatric pain medicine we try to avoid medicines and use them sparingly, but if a non-functional child becomes functional on a medicine that may restore quality of life – that should be central to pain management.’
Ms Ellis recalls an example of a 14-year-old girl prescribed an opioid to be taken before menstruation for 4–5 days. While some healthcare professionals were quick to label this approach an addiction risk, it perhaps kept her in school during severe periods while investigations took place for endometriosis or polycystic ovarian syndrome.
‘Pharmacists concerned about higher-risk medicines should focus conversations on functional benefit, asking “Is this improving your ability to do things?”’ she said. ‘If not, initiate a discussion about whether to continue therapy, given the potential harms.’
With her mum’s support and extensive physical therapies, Laura was able to walk into her first day of high school without a walking stick. While she has good and bad days and constant flare ups, there are wins along the way – such as being able to start carrying a backpack rather than relying on a roller case.
‘It’s an invisible disability with constant pain that isn’t linear – there are different levels and sensations all the time and that changes the way I approach daily life,’ Laura said.
‘[But] when mum said I will keep fighting for you – it was almost like a promise, and she’s always kept it.’
[post_title] => Early action prevents lifelong chronic pain in children
[post_excerpt] => A new report lays bare the impact of chronic pain in young people. An expert shares practical steps for pharmacists to improve care.
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[post_content] => The various dementias are a huge cause of death in Australia. Despite some light on the horizon, there are still no effective treatments. AP explores the latest in dementia research.
Dementia is the second leading cause of death in Australia.1 The number of people living with the disease is expected to increase substantially as the population ages, potentially straining health systems.2
Despite accelerated research, including trials of more advanced compounds and recent Victorian Government grants supporting mRNA-based projects, effective treatments remain elusive.3
According to Dementia Australia's Executive Director of Services, Advocacy and Research, Dr Kaele Stokes (she/her), an estimated 433,000 Australians are currently living with dementia, including 29,000 people living with younger-onset dementia (when symptoms emerge before age 65).1
While there have been important advances in pharmaceutical research in the dementia field in recent years, Dr Stokes says, new medicines to date have limited application, availability and efficacy, and they do not stop the progression of dementia.
It is important to ensure health systems support everyone living with dementia now, she adds, noting that the new medicines may not work for many people with the condition, particularly patients who have lived with dementia for some time.
‘We don’t have an approach here in Australia that focuses on the importance of brain health across the life course,’ she says.
‘While we’re good at picking up other diseases, such as cardiovascular disease or diabetes, and putting steps in place to ensure the risks of severity in those conditions are minimised, we don’t really have conversations about brain health in a healthcare setting.’
Diagnosing dementia for younger and older people
Dr Stokes says while diagnostic tools are improving, diagnosing dementia is still a complex process.
Dementia is still seen as an older person’s disease, she adds, and it can be difficult for a person in their 40s or 50s to receive a dementia diagnosis.
According to a 2025 study in Translational Psychiatry, young-onset dementia in people aged under 65 years globally increased substantially in prevalence and incidence between 1990 and 2021 compared with overall people with dementia – and with a higher burden on women.4 The three highest risk factors were smoking, high body mass index and high fasting plasma glucose levels, while population growth was the largest contributor to the significant increase.4
‘There’s still a real fear and stigma around wanting to talk about brain health or talking to a healthcare professional about concerns around changes in cognition,’ Dr Stokes says.
‘But actually there are lots of reasons why it’s important to do that. A mix of pharmacological and non-pharmacological interventions can make a difference to quality of life and reduce the stress that somebody might be experiencing.’
It is important for people to focus on modifiable risk factors, potentially reducing the risk of developing dementia by about 45% by avoiding smoking or drinking too much and by maintaining a healthy diet, exercising regulary, and ensuring hearing and vision problems are identified and dealt with, Dr Stokes says.
For those at later stages of their lives, it’s important to avoid social isolation and to keep the brain active, she adds.
‘Learning new things can be really important – stretching the brain, firing up the neurons, to keep your brain active.’
Pharmacological advances
Healthcare professionals have high hopes for the potential benefits of newly available monoclonal antibody treatments for Alzheimer’s disease.5
University of Melbourne and Florey Institute Professor of Dementia Research Colin Masters, widely recognised as a world expert in the field of neurodegenerative diseases, estimates there are about 100 compounds in the pharmaceutical pipeline presently that are progressing through the trial stages.
‘Better forms, more effective forms, are coming within the next couple of years,’ he declares. ‘We’ve got to learn how to use them and manage all the adverse effects as well.’ He is optimistic about the future of dementia treatments – potentially including a routine vaccination.
‘The writing is on the wall,’ he says. ‘If the passive immunotherapies work, then everyone will be working on an active vaccination program. In other words, at age 50 or whatever, you just run up to your primary care physician, they do a blood test, you’re on the pathway – you get a shot of peptide in your arm.’
The most promising drug now on the horizon is trontinemab, Prof Masters says. It's a reinvented form of the monoclonal antibody gantenerumab – a drug that didn’t make it to market because of a lack of efficacy. Even so, he adds, gantenerumab has been found effective for certain conditions. ‘We’ve been trialling it for nearly 10 years now,’ Prof Masters says, ‘and we published in Lancet Neurology9 [in June 2025] that in early-onset familial types of Alzheimer’s disease, gantenerumab in high doses was effective in pre-clinical disease in young individuals who are at 100% risk of developing Alzheimer’s disease.’ Trontinemab, he adds, is the natural successor to gantenerumab.
In April, Roche announced the results of a phase II trial of trontinemab delivered via the “Brainshuttle” system, which found ‘rapid and deep, dose-dependent reduction of amyloid plaques in the brain’.10 At the same time, Roche announced it would begin a phase III trial of the drug later this year.10
‘It’s the next generation; it’s a major advance,’ Prof Masters says, explaining that the bispecific molecule of trontinemab is designed to go straight across the blood-brain barrier, so doses of the drug can be far smaller.
‘It’s the first antibody designed to do this, and a lot of companies are copying it right now, because it works so well.’
According to data released from the Roche trials, trontinemab causes far fewer and less severe adverse effects than gantenerumab, he points out.
Other promising Alzheimer’s disease treatments include the monoclonal antibody donanemab. It is marketed as Kisunla by Eli Lilly, and in May 2025 it was approved by the Therapeutic Goods Administration.11
Lecanemab, marketed as Leqembi, has not yet been approved in Australia, but Prof Masters says full results of a pre-clinical trial are expected by the end of 2027 and he and his colleagues expect a positive result.
All these monoclonal antibody drugs are most effective in the early stages of Alzheimer’s disease, so early diagnosis is critical.12 In July this year, the Victorian Government also announced more than $537,000 in grants to two Florey researchers for two Alzheimer’s research projects.
These are aimed at treating and preventing the disease with mRNA technology, which was developed during the pandemic for COVID-19 vaccines.13
Pharmacist dementia support in the community
PSA’s Dementia Support Pharmacist Project in South Australia is an innovative project and model of practice aimed at keeping people with dementia at home and in the community for longer.14
Two pharmacists are employed on the project. They job-share to support clients with dementia medication management needs, understanding and choices, says South Australia and Northern Territory PSA Manager Helen Stone FPS (she/her).
The pharmacists act as patient advocates, provide flexible care for patients with complex comorbidities, and work with other members of the care team, including GPs, community pharmacists, nursing and care workers and families, she adds. Initial appointments are held in the patient's home, preferably with follow-ups either personally, by telephone or collaboration application such as MS Teams. A report prepared by the pharmacist is shared with the patient and, with consent, to treating medical and care teams, which may recommend an action plan to change or deprescribe medicines. Education about medicine use in dementia is also provided to health professionals and community groups across regional areas of the state.
‘This is a much-needed service; it is accessible, but there are a lot more people we can’t yet support,’ Ms Stone says. PSA has demonstrated that pharmacists working directly with patients and liaising with the care team can provide valuable support for patients with complex conditions and multimorbidities.
The project began in May 2024 and has been extended to June 2026. Ms Stone recently submitted a proposal to SA Health to expand the program and include a further five FTE pharmacists to cover metropolitan Adelaide.
Dementia care pharmacists can help with complex deprescribing of medicines and tapering of antidepressants where needed. They can provide professional advice to family members caring for patients with dementia that can empower carers as advocates in cases, for instance, of inadequate pain management.
Medicine administration frustrations can be avoided when dose time changes can be suggested.
Project pharmacist Dee-Anne Hull MPS (she/her) says pharmacist dementia support work helps in areas where it is needed most. ‘It has shown us where gaps in health care are in rural and remote areas of our state, but also within the pharmacy profession itself,’ she says. ‘A lot of pharmacists openly admit that dementia scares them, and they don’t really know where to start.
‘My advice is to make this an area of focus for CPD activities; check out the numerous PSA resources available, particularly those on palliative care and deprescribing, but also check out websites like Dementia Australia, Dementia Training Australia and the Wicking Dementia Centre,’ she adds.
‘Think about ways that you could support someone who is caring for a person living with dementia and the carer’s burden that may be associated with this, because that’s often where the support is needed the most.’
Positive response
Dementia Support Pharmacist Project pharmacist Nicola Sander MPS (she/her) says she has seen ‘overwhelming support and positive feedback’ for the project.
‘We have seen considerable benefit for people who are still living at home and are trying to manage their medicines.
Ms Sander sees this dementia support career pathway as ideal for an early career pharmacist and suggests that training in deprescribing and dementia-specific areas would be useful.
After a lengthy consultation with one client living at home, the client’s family and her doctor, Ms Sander recommended medicine management changes. The doctor was reluctant, so the client’s daughter found a doctor who was willing to be part of a multidisciplinary team, Ms Sander says, which included deprescribing strategies and pain support management.
After a recent visit to the geriatrician, the client’s daughter reported that her mother’s Mini‐Mental State Examination had improved from 12/30 to 19/30.
The daughter and the geriatrician attributed the client’s improvement to ‘better control of pain and overall improvement to her mood, as she has felt more supported and less depressed' since.
Ms Stone, whose Churchill Fellowship palliative care research – To articulate a framework for the role of Palliative Care Pharmacist in community and aged care in Australia – Churchill Trust15 – informed the Dementia Support Pharmacist Project, says that education, training and curiosity help pharmacists to start understanding dementia care more fully.
She encourages everyone to complete a Program of Experience in the Palliative Approach (PEPA) placement.
‘A dementia diagnosis can be devastating for people and their families; medications can have a benefit but can also impair cognition, so support from a pharmacist can be very valuable.'
References
- Australian Institute of Health and Welfare. Dementia In Australia. 2024. At: www.aihw.gov.au/reports/dementia/dementia-in-aus/contents/population-health-impacts-of-dementia/deaths-due-to-dementia
- Dementia Australia. Dementia facts and figures. 2024. At: www.dementia.org.au/about-dementia/dementia-facts-and-figures
- Florey Institute for Neuroscience and Mental Health. Harnessing mRNA to prevent and slow Alzheimer’s disease. 2025. At: https://florey.edu.au/news/2025/07/harnessing-mrna-to-prevent-and-slow-alzheimers-disease/
- He Q, Wang W, Zhang Y, et al. Global burden of young-onset dementia, from 1990 to 2021: an age-period-cohort analysis from the global burden of disease study 2021. Transl Psychiatry 2025. Epub 2025, 17 February.
- Ramanan VK, Armstrong MJ, Choudhury P, et al. Antiamyloid monoclonal antibody therapy for Alzheimer disease. Neurology 2023;101(19)842–52. At: www.neurology.org/doi/10.1212/WNL.0000000000207757
- World Health Organization. Dementia. 2025. At: www.who.int/en/news-room/fact-sheets/detail/dementia
- Mayo Clinic. Alzheimer’s disease. 2025. At: www.mayoclinic.org/diseases-conditions/alzheimers-disease/symptoms-causes/syc-20350447
- Eyting M, Xie M, Michalik F, et al. A natural experiment on the effect of herpes zoster vaccination on dementia. Nature 2025. Epub 2025 2 April. At www.nature.com/articles/s41586-025-08800-x
- Safety and efficacy of long-term gantenerumab treatment in dominantly inherited Alzheimer's disease: an open-label extension of the phase 2/3 multicentre, randomised, double-blind, placebo-controlled platform DIAN-TU trial. Bateman, Randall J et al. Lancet Neurology 2025; 24(4):316–30.
- Roche. Roche presents novel therapeutic and diagnostic advancements in Alzheimer’s at AP/PD 2025. 2025. At: www.roche.com/media/releases/med-cor-2025-04-03
- Burge K. Treatment to slow early Alzheimer’s gets TGA approval. newsGP 2025. At: www1.racgp.org.au/newsgp/clinical/treatment-to-slow-early-alzheimer-s-gets-tga-appro
- Promising results of new Alzheimer’s drug published – early diagnosis is key. 2023. At: www.dementia.org.au/media-centre/media-releases/promising-results-new-alzheimers-drug-published-early-diagnosis-key
- Victoria State Government. mRNA Victoria. Research. July 2025. At: https://djsir.vic.gov.au/mrna-victoria/research
- Sander N, Jull DA. Bridging the gap: how dementia support pharmacists are transforming care in rural South Australia. Issue 91. June 2, 2025. At: https://ruralhealth.org.au/partyline/bridging-the-gap-how-dementia-support-pharmacists-are-transforming-care-in-rural-south-australia/
- Stone H. To articulate a framework for the role of the palliative care pharmacist in community and aged care in Australia. Winston Churchill Trust 2025. At: www.churchilltrust.com.au/project/to-articulate-a-framework-for-the-role-of-palliative-care-pharmacist-in-community-and-aged-care-in-australia/
[post_title] => Advancing dementia care in pharmacy
[post_excerpt] => The various dementias are a huge cause of death in Australia. Despite some light on the horizon, there are still no effective treatments.
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[post_content] => Pharmacists are asked to lead the shift from reliever-only inhalers to inhaled corticosteroid-containing regimens and to minimise short courses of oral corticosteroids.
Just under 3 million Australians live with asthma. The condition has the eighth-highest disease burden in the nation, and it is one of the most significant chronic conditions in children.
Guided by the results of large trials, recommendations for asthma management in adults and adolescents are changing, and pharmacists need to be aware of updated guidelines. The Australian Asthma Handbook was updated yesterday (16 September 2025) to reflect new thinking on asthma care and management.
What are the key updates?
Three key changes have been made to the Australian Asthma Handbook, including:
-
- All adults and adolescents with confirmed asthma should be taking inhaled corticosteroid-containing treatment and not as-needed short-acting beta2-agonists (SABAs) alone. Asthma can be well controlled with maintenance and reliever therapy, and a small proportion of patients with severe asthma may be eligible for biologics.
- An emphasis on the importance of limiting oral corticosteroids, which have been associated with a range of different harms, including damage to bone health, cataracts and type 2 diabetes.
- Health professionals should be aware the handbook has greater guidance for treating children aged 1–5 who are living with asthma and a recommendation that some older children should also be on low-dosage ICS maintenance therapy.
Why have the guidelines been updated?
Overuse of SABAs has been linked to poor asthma control and preventable hospitalisations.
‘The evidence is that the risks of SABA alone have become clearer and that we were overusing a not very effective and not very safe therapy,’ said Professor Nick Zwar, Executive Dean of Bond University’s Faculty of Health Sciences and Medicine, and Chair of the Australian Asthma Handbook Guidelines Committee.
‘Budesonide-formoterol, taken only as needed, is recommended in place of SABA. Maintenance and reliever therapy is now recommended as the next step up.’
The risks of SABA overuse include a lack of bronchodilator response over time, and the possibility that some people may have quite a severe asthma attack and end up in the hospital emergency department (ED), or hospitalised, when they don’t need to be.
There is very strong evidence to demonstrate that all adolescents and adults living with asthma should be treated with ICS, said pharmacist and Clinical Executive Lead at the National Asthma Council Australia, Debbie Rigby FPS.
‘Just having the SABA alone only treats one component of asthma, which is the bronchoconstriction, whereas having the low-dose ICS helps manage the inflammation and mucus production,’ she said. ‘I think that’s the biggest shift for us, pharmacists and doctors: helping patients to understand that asthma is a chronic inflammatory condition.’
What are the risks of poor asthma control?
Inadequately managed asthma can be a life-threatening condition, Ms Rigby stressed, noting there were 474 asthma-related deaths in Australia in 2023.
‘Those deaths shouldn’t be happening. Many of those people who did die from asthma or asthma-related causes would have been perceived as having mild, intermittent symptoms,’ she said. ‘Without wanting to scare patients, we should be really highlighting the consequences of not having good control of their asthma.’
Why is SABA still overused?
Despite access to long-acting beta2 agonists (ICS–LABAs), SABA use remains high for a range of reasons. These include cost, convenience and patient reluctance to medicate every day when they are accustomed to using a reliever-only when they have an asthma attack, Ms Rigby said.
Health professionals understand that many people are reluctant to use a preventer inhaler, but health professionals need to help them understand that they have a ‘chronic inflammatory condition, which may flare up from time to time’.
Effects of the cost-of-living crisis should not be underestimated either. However, the price gap between over-the-counter salbutamol and prescription asthma medicines is now narrowing, with 60-day dispensing for patients who are stable and, from January 2026, the co-payment for medicines being reduced from $31.60 to $25 per prescription.
The Australian uptake of Maintenance and Reliever Therapy (MART) has also been slow, despite strong evidence and subsidy on the Pharmaceutical Benefits Scheme. The evidence of large-scale trials has shown the importance of shifting patients with mild asthma onto anti-inflammatory reliever therapy on an as-needed basis, Ms Rigby said.
‘The evidence basically says it reduces the risk of severe exacerbations requiring ED or hospitalisation, or requiring oral corticosteroids,’ she said.
For practical guidance on discussing the guideline changes with patients, the role of prescribing pharmacists, and how biologics fit into care, don’t miss the October cover story in Australian Pharmacist.
[post_title] => New asthma guidelines released
[post_excerpt] => Pharmacists are asked to lead the shift from reliever to inhaled corticosteroid regimens and to minimise use of oral corticosteroids.
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[post_content] => Tomorrow (Thursday 25 September 2025) is World Pharmacists Day – an annual milestone for the past 16 years that celebrates the pharmacy profession worldwide and amplifies its essential contribution to health systems.
The theme for this year’s World Pharmacists Day, as chosen by the International Pharmaceutical Federation (FIP) is ‘Think Health, Think Pharmacist’.
The theme reflects the vital role of pharmacists both in Australia and internationally, and the need to routinely embed them across all areas of the health system.
Ahead of the day, FIP President, Australia’s Paul Sinclair AM MPS said ‘Think Health, Think Pharmacist’ is more than a campaign – it’s a call to action.
‘Pharmacists are crucial to the safe use of medicines, chronic disease management and public health delivery. Investing in them is investing in stronger health systems,’ he said.
‘As the world faces rising healthcare demands, economic uncertainty, and growing threats like antimicrobial resistance and climate change – pharmacists remain key to ensuring safe, cost-effective, and accessible care.
‘From improving health literacy and delivering vaccinations to ensuring the safe use of medicines, pharmacists are an indispensable part of our health systems, especially in underserved communities.’
Getting involved in World Pharmacists Day
Australian pharmacists can get involved by engaging patients, politicians and stakeholders in conversation. Pharmacists can also champion the profession through social media, including:
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[post_content] => As US regulators flag new warnings, the Therapeutic Goods Administration (TGA) and Australian experts have weighed in on what the evidence shows.
Paracetamol has widely been considered the safest analgesic to relieve fever and pain during pregnancy. Fever higher than 38.9°C for at least 24 hours during pregnancy is linked to higher chances of miscarriage, preterm birth, stillbirth and certain malformations including neural tube defects like spina bifida.
Yet the US Food and Drug Administration (FDA) announced it intends to add a warning label to the medicine, citing a ‘possible association’ between autism in children and the use of acetaminophen (paracetamol) during pregnancy.
This proposed regulation change, along with updated advice given to the American Academy of Pediatrics among other medical groups, follows an announcement from the US President linking acetaminophen (Tylenol) (known as paracetamol in Australia) to autism – calling on pregnant women to avoid it.
Australia’s Chief Medical Officer Micahel Kidd has rejected claims about the use of paracetamol in pregnancy and the risk of developing ADHD or autism. So what are other experts saying?
TGA: ‘safe for use in pregnancy’
Paracetamol remains Pregnancy Category A in Australia, meaning that it is considered safe for use in pregnancy, a spokesperson for the TGA told Australian Pharmacist.
‘The use of medications in pregnancy is subject to clinical, scientific and toxicological evaluation at the time of registration of a medicine in Australia,’ the spokesperson said.
‘Paracetamol has been taken by a large number of pregnant women and women of childbearing age without any proven increase in the frequency of malformations or other harmful effects on the fetus having been observed.’
Paracetamol is still the recommended treatment option for pain or fever in pregnant women when used as directed, the TGA said.
‘Importantly, untreated fever and pain can pose risks to the unborn baby, highlighting the importance of managing these symptoms with recommended treatment.
The spokesperson said that the TGA maintains robust post-market safety surveillance and pharmacovigilance processes for all medicines registered in Australia, including paracetamol.
‘When safety signals are identified for a medicine, they are subject to detailed clinical and scientific investigation to confirm that a safety issue exists, and if confirmed, what regulatory actions are most appropriate to mitigate the risk,’ the spokesperson said. ‘The TGA has no current active safety investigations for paracetamol and autism, or paracetamol and neurodevelopmental disorders more broadly.’
Australia is not the only nation holding firm; international peer regulators, such as the UK Medicines and Healthcare products Regulatory Agency, continue to advise that paracetamol be used according to the approved Product Information.
In its 2019 review, the European Medicines Agency also determined that the available evidence on paracetamol’s effects on childhood neurodevelopment is inconclusive.
Is there any evidence linking paracetamol in pregnancy with autism?
Some systematic reviews have reported associations between paracetamol use in pregnancy and autism in children – usually prolonged, high-dose use that exceeds recommendations.
Of central interest to the US Government's claim is a 2025 systematic review which made the claim of ‘strong evidence of a relationship between prenatal acetaminophen use and increased risk of ASD in children’.
But the quality of these studies have been subject to significant critical review.
Professor Margie Danchin, a paediatrician and group leader of the Murdoch Children’s Research Institute’s Vaccine Uptake Group, refuted the evidence base, made up of observational studies, linking paracetamol to autism.
‘The cause of fever for the women in those studies is probably what caused the problems later on developmentally for the children, not the fact that they took Panadol for that fever.’
Additionally, Prof Danchin said many of the women who participated in these studies were asked several years postpartum whether they took paracetamol during pregnancy, further undermining accuracy.
More recent and robust studies contradict these claims and support the prevailing evidence that paracetamol is not causally linked to autism or ADHD, the TGA said.
Experts point to a Swedish cohort study as the most persuasive evidence on paracetamol and autism. Published last year, it analysed records for nearly 2.5 million children born between 1995 and 2019, identifying autism diagnoses and verifying whether mothers used paracetamol during pregnancy.
Crucially, the investigators conducted a sibling-comparison analysis, assessing pairs in which one child was prenatally exposed to paracetamol and the other was not. Because siblings share much of their genetics, household environment and maternal health influences, this approach helps isolate the impact of specific factors such as paracetamol.
In the largest study of its kind to date, no association was found between prenatal paracetamol exposure and autism.
Imparting safe and accurate information
Prof Danchin called the claim linking acetaminophen exposure in utero to autism ‘disinformation’.
‘At the moment, the biggest issue at play is trust,’ she said.
The danger of ‘repeatedly repeating myths’ is that it further entrenches them.
‘That sort of repetition becomes very sticky. People hear it all the time, and it becomes harder and harder to counter,’ Prof Danchin said.
However, health professionals should ensure the right messages get across, she said.
When counselling patients on paracetamol use in pregnancy, PSA has advised pharmacists to take the following approach:
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[post_content] => A new report lays bare the impact of chronic pain in young people. During Kids in Pain Week (22–28 September), an expert shares practical steps for pharmacists to improve care.
Sydney-based Laura was just 10 years old when a bout of shingles left her with constant, debilitating pain. Laura went from being a fit and active middle sister to being unable to walk or move without a wheelchair at the age of 11, and completely reliant on her family for care. Doctors were stumped and investigations proved fruitless.
‘I was so sick of doctors – waiting for the doctors and waiting to do anything and just so ready to give up,’ Laura said.
[caption id="attachment_30566" align="aligncenter" width="500"] Laura with her mum Michelle[/caption]
When living with chronic pain, it’s easy to feel misunderstood and lonely, she shared.
‘Laura was having a really hard time, was depressed, barely talking and struggling. It was so hard to see her like that,’ Laura’s mum, Michelle said.
‘People underestimate how chronic pain may start as a physical issue but then becomes a mental health issue when everything is so uncertain and you aren’t sure if life will ever be what it was.’
Around one in five children aged 6–18 live with chronic pain, which equates to approximately 877,000 Australian kids – according to Australian Bureau of Statistics (ABS) data.
The inaugural Kids in Pain Report from Chronic Pain Australia shows how pain affects every aspect of these children’s lives, as well as their families, and the many who are likely unaccounted for, said pharmacist and Chronic Pain Australia chairperson, Nicolette Ellis MPS.
‘In 2019 the World Health Organization recommended that chronic pain be recognised as a condition in its own right and provided a way to capture that in healthcare data with ICD-11 coding,’ she said. ‘But chronic pain isn’t recognised as a condition in Australia; it’s recognised only as a symptom of an injury or another condition.’
[caption id="attachment_30564" align="aligncenter" width="500"] Nicolette Ellis MPS[/caption]
Without robust prevalence data, chronic pain will remain missing from national policy – including the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme, Ms Ellis warned.
‘That cascades down into service planning and investment, which is not currently matched to need,’ she said. ‘For example, Australia only has nine specialist paediatric pain clinics; Tasmania and the Northern Territory have none, so families often travel 4–6 hours for specialist appointments.’
What does chronic pain look like in children?
Most (71%) of children experience musculoskeletal pain, typically due to rheumatoid arthritis and autoimmune conditions as well as lower-back pain, knee pain and other joint pain. Migraine and headaches, abdominal pain, connective-tissue disorders, neuropathic pain and pelvic pain are also prominent.
‘Most children have overlapping conditions – for example, migraine with abdominal pain, or musculoskeletal and neuropathic pain – so it’s rarely a single tidy diagnosis,’ Ms Ellis said.
There is a high correlation between neurodivergence and pain, with almost three-quarters (72.9%) of children with chronic pain having at least one neurodivergent diagnosis.
‘Life can be more stressful for neurodivergent individuals, producing hormones that amplify pain signals,’ she said.
About 60% of children with chronic pain also identified as female.
‘Women and girls have denser nerve networks and different immune systems,’ Ms Ellis said. ‘Fluctuations in oestrogen can also increase pain signals, while testosterone tends to reduce them.’
Why is there such a long road to diagnosis?
For over 64% of children living with chronic pain, it took at least 3 years to receive a diagnosis.
‘Culturally, there’s a belief that persistent pain is an “older person’s condition”,’ Ms Ellis said. ‘So many children’s pain is dismissed.’
It’s often assumed there is another reason driving the symptoms.
‘Common explanations given to families are anxiety, a mental-health issue, “growing pains” that will resolve, or school avoidance,’ she said. ‘That invalidates the child and parent, and delays diagnosis.’
Children can face significant challenges navigating the healthcare system, getting answers, and accessing quality treatment, leading to cascading consequences.
‘Around 80% of children have a secondary mental health challenge, report sleep issues and forgo sport and similar activities,’ she said. ‘Over 80% miss school, about 1 day per week on average, with many finding the school system inflexible and invalidating, with pain dismissed or labelled as avoidance.’
Should a child experience ongoing, persistent pain, it should be taken ‘very seriously’ by health professionals – including pharmacists – with early intervention and thorough assessment ideally taking place within the first 3–6 months.
‘Early action reduces chronicity, helps build tools and confidence in self-management, and helps keep children in school and engaged socially,’ Ms Ellis said.
What’s the pharmacist’s role?
Parents reported that they often see their pharmacist first to discuss their child's pain condition. To expedite diagnosis and ensure appropriate care, Chronic Pain Australia has released a Pharmacist Guide which includes language tips for discussing pain with children, ways to explain pain, and what good pain management looks like.
‘Pharmacists should ask how long the pain has been present and validate that it’s challenging to live with,’ Ms Ellis said. ‘Emphasise the importance of seeing a local GP for assessment and early diagnosis.’
Other key language tips include using ‘lives with pain’ over ‘suffers from’. Pharmacists should also describe ‘bad” or ‘challenging’ days rather than ‘flare-ups’.
‘Link with local providers, such as occupational therapists, physiotherapists and psychologists – who understand different communication and treatment needs, including for neurodivergent children who may express pain differently,’ she said.
When addressing children with neurodivergence, pharmacists should inquire how best to communicate with them, what topics to avoid and what information would help.
‘Communication should always be age-appropriate and family-centred,’ Ms Ellis said. ‘The goal is to create a friendly, approachable environment where children feel comfortable sharing, while parents can help fill in the picture when needed.’
How should symptom management be approached?
Management approaches for chronic pain depend on the child, condition, and whether function improves, Ms Ellis said.
‘In paediatric pain medicine we try to avoid medicines and use them sparingly, but if a non-functional child becomes functional on a medicine that may restore quality of life – that should be central to pain management.’
Ms Ellis recalls an example of a 14-year-old girl prescribed an opioid to be taken before menstruation for 4–5 days. While some healthcare professionals were quick to label this approach an addiction risk, it perhaps kept her in school during severe periods while investigations took place for endometriosis or polycystic ovarian syndrome.
‘Pharmacists concerned about higher-risk medicines should focus conversations on functional benefit, asking “Is this improving your ability to do things?”’ she said. ‘If not, initiate a discussion about whether to continue therapy, given the potential harms.’
With her mum’s support and extensive physical therapies, Laura was able to walk into her first day of high school without a walking stick. While she has good and bad days and constant flare ups, there are wins along the way – such as being able to start carrying a backpack rather than relying on a roller case.
‘It’s an invisible disability with constant pain that isn’t linear – there are different levels and sensations all the time and that changes the way I approach daily life,’ Laura said.
‘[But] when mum said I will keep fighting for you – it was almost like a promise, and she’s always kept it.’
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[post_content] => The various dementias are a huge cause of death in Australia. Despite some light on the horizon, there are still no effective treatments. AP explores the latest in dementia research.
Dementia is the second leading cause of death in Australia.1 The number of people living with the disease is expected to increase substantially as the population ages, potentially straining health systems.2
Despite accelerated research, including trials of more advanced compounds and recent Victorian Government grants supporting mRNA-based projects, effective treatments remain elusive.3
According to Dementia Australia's Executive Director of Services, Advocacy and Research, Dr Kaele Stokes (she/her), an estimated 433,000 Australians are currently living with dementia, including 29,000 people living with younger-onset dementia (when symptoms emerge before age 65).1
While there have been important advances in pharmaceutical research in the dementia field in recent years, Dr Stokes says, new medicines to date have limited application, availability and efficacy, and they do not stop the progression of dementia.
It is important to ensure health systems support everyone living with dementia now, she adds, noting that the new medicines may not work for many people with the condition, particularly patients who have lived with dementia for some time.
‘We don’t have an approach here in Australia that focuses on the importance of brain health across the life course,’ she says.
‘While we’re good at picking up other diseases, such as cardiovascular disease or diabetes, and putting steps in place to ensure the risks of severity in those conditions are minimised, we don’t really have conversations about brain health in a healthcare setting.’
Diagnosing dementia for younger and older people
Dr Stokes says while diagnostic tools are improving, diagnosing dementia is still a complex process.
Dementia is still seen as an older person’s disease, she adds, and it can be difficult for a person in their 40s or 50s to receive a dementia diagnosis.
According to a 2025 study in Translational Psychiatry, young-onset dementia in people aged under 65 years globally increased substantially in prevalence and incidence between 1990 and 2021 compared with overall people with dementia – and with a higher burden on women.4 The three highest risk factors were smoking, high body mass index and high fasting plasma glucose levels, while population growth was the largest contributor to the significant increase.4
‘There’s still a real fear and stigma around wanting to talk about brain health or talking to a healthcare professional about concerns around changes in cognition,’ Dr Stokes says.
‘But actually there are lots of reasons why it’s important to do that. A mix of pharmacological and non-pharmacological interventions can make a difference to quality of life and reduce the stress that somebody might be experiencing.’
It is important for people to focus on modifiable risk factors, potentially reducing the risk of developing dementia by about 45% by avoiding smoking or drinking too much and by maintaining a healthy diet, exercising regulary, and ensuring hearing and vision problems are identified and dealt with, Dr Stokes says.
For those at later stages of their lives, it’s important to avoid social isolation and to keep the brain active, she adds.
‘Learning new things can be really important – stretching the brain, firing up the neurons, to keep your brain active.’
Pharmacological advances
Healthcare professionals have high hopes for the potential benefits of newly available monoclonal antibody treatments for Alzheimer’s disease.5
University of Melbourne and Florey Institute Professor of Dementia Research Colin Masters, widely recognised as a world expert in the field of neurodegenerative diseases, estimates there are about 100 compounds in the pharmaceutical pipeline presently that are progressing through the trial stages.
‘Better forms, more effective forms, are coming within the next couple of years,’ he declares. ‘We’ve got to learn how to use them and manage all the adverse effects as well.’ He is optimistic about the future of dementia treatments – potentially including a routine vaccination.
‘The writing is on the wall,’ he says. ‘If the passive immunotherapies work, then everyone will be working on an active vaccination program. In other words, at age 50 or whatever, you just run up to your primary care physician, they do a blood test, you’re on the pathway – you get a shot of peptide in your arm.’
The most promising drug now on the horizon is trontinemab, Prof Masters says. It's a reinvented form of the monoclonal antibody gantenerumab – a drug that didn’t make it to market because of a lack of efficacy. Even so, he adds, gantenerumab has been found effective for certain conditions. ‘We’ve been trialling it for nearly 10 years now,’ Prof Masters says, ‘and we published in Lancet Neurology9 [in June 2025] that in early-onset familial types of Alzheimer’s disease, gantenerumab in high doses was effective in pre-clinical disease in young individuals who are at 100% risk of developing Alzheimer’s disease.’ Trontinemab, he adds, is the natural successor to gantenerumab.
In April, Roche announced the results of a phase II trial of trontinemab delivered via the “Brainshuttle” system, which found ‘rapid and deep, dose-dependent reduction of amyloid plaques in the brain’.10 At the same time, Roche announced it would begin a phase III trial of the drug later this year.10
‘It’s the next generation; it’s a major advance,’ Prof Masters says, explaining that the bispecific molecule of trontinemab is designed to go straight across the blood-brain barrier, so doses of the drug can be far smaller.
‘It’s the first antibody designed to do this, and a lot of companies are copying it right now, because it works so well.’
According to data released from the Roche trials, trontinemab causes far fewer and less severe adverse effects than gantenerumab, he points out.
Other promising Alzheimer’s disease treatments include the monoclonal antibody donanemab. It is marketed as Kisunla by Eli Lilly, and in May 2025 it was approved by the Therapeutic Goods Administration.11
Lecanemab, marketed as Leqembi, has not yet been approved in Australia, but Prof Masters says full results of a pre-clinical trial are expected by the end of 2027 and he and his colleagues expect a positive result.
All these monoclonal antibody drugs are most effective in the early stages of Alzheimer’s disease, so early diagnosis is critical.12 In July this year, the Victorian Government also announced more than $537,000 in grants to two Florey researchers for two Alzheimer’s research projects.
These are aimed at treating and preventing the disease with mRNA technology, which was developed during the pandemic for COVID-19 vaccines.13
Pharmacist dementia support in the community
PSA’s Dementia Support Pharmacist Project in South Australia is an innovative project and model of practice aimed at keeping people with dementia at home and in the community for longer.14
Two pharmacists are employed on the project. They job-share to support clients with dementia medication management needs, understanding and choices, says South Australia and Northern Territory PSA Manager Helen Stone FPS (she/her).
The pharmacists act as patient advocates, provide flexible care for patients with complex comorbidities, and work with other members of the care team, including GPs, community pharmacists, nursing and care workers and families, she adds. Initial appointments are held in the patient's home, preferably with follow-ups either personally, by telephone or collaboration application such as MS Teams. A report prepared by the pharmacist is shared with the patient and, with consent, to treating medical and care teams, which may recommend an action plan to change or deprescribe medicines. Education about medicine use in dementia is also provided to health professionals and community groups across regional areas of the state.
‘This is a much-needed service; it is accessible, but there are a lot more people we can’t yet support,’ Ms Stone says. PSA has demonstrated that pharmacists working directly with patients and liaising with the care team can provide valuable support for patients with complex conditions and multimorbidities.
The project began in May 2024 and has been extended to June 2026. Ms Stone recently submitted a proposal to SA Health to expand the program and include a further five FTE pharmacists to cover metropolitan Adelaide.
Dementia care pharmacists can help with complex deprescribing of medicines and tapering of antidepressants where needed. They can provide professional advice to family members caring for patients with dementia that can empower carers as advocates in cases, for instance, of inadequate pain management.
Medicine administration frustrations can be avoided when dose time changes can be suggested.
Project pharmacist Dee-Anne Hull MPS (she/her) says pharmacist dementia support work helps in areas where it is needed most. ‘It has shown us where gaps in health care are in rural and remote areas of our state, but also within the pharmacy profession itself,’ she says. ‘A lot of pharmacists openly admit that dementia scares them, and they don’t really know where to start.
‘My advice is to make this an area of focus for CPD activities; check out the numerous PSA resources available, particularly those on palliative care and deprescribing, but also check out websites like Dementia Australia, Dementia Training Australia and the Wicking Dementia Centre,’ she adds.
‘Think about ways that you could support someone who is caring for a person living with dementia and the carer’s burden that may be associated with this, because that’s often where the support is needed the most.’
Positive response
Dementia Support Pharmacist Project pharmacist Nicola Sander MPS (she/her) says she has seen ‘overwhelming support and positive feedback’ for the project.
‘We have seen considerable benefit for people who are still living at home and are trying to manage their medicines.
Ms Sander sees this dementia support career pathway as ideal for an early career pharmacist and suggests that training in deprescribing and dementia-specific areas would be useful.
After a lengthy consultation with one client living at home, the client’s family and her doctor, Ms Sander recommended medicine management changes. The doctor was reluctant, so the client’s daughter found a doctor who was willing to be part of a multidisciplinary team, Ms Sander says, which included deprescribing strategies and pain support management.
After a recent visit to the geriatrician, the client’s daughter reported that her mother’s Mini‐Mental State Examination had improved from 12/30 to 19/30.
The daughter and the geriatrician attributed the client’s improvement to ‘better control of pain and overall improvement to her mood, as she has felt more supported and less depressed' since.
Ms Stone, whose Churchill Fellowship palliative care research – To articulate a framework for the role of Palliative Care Pharmacist in community and aged care in Australia – Churchill Trust15 – informed the Dementia Support Pharmacist Project, says that education, training and curiosity help pharmacists to start understanding dementia care more fully.
She encourages everyone to complete a Program of Experience in the Palliative Approach (PEPA) placement.
‘A dementia diagnosis can be devastating for people and their families; medications can have a benefit but can also impair cognition, so support from a pharmacist can be very valuable.'
References
- Australian Institute of Health and Welfare. Dementia In Australia. 2024. At: www.aihw.gov.au/reports/dementia/dementia-in-aus/contents/population-health-impacts-of-dementia/deaths-due-to-dementia
- Dementia Australia. Dementia facts and figures. 2024. At: www.dementia.org.au/about-dementia/dementia-facts-and-figures
- Florey Institute for Neuroscience and Mental Health. Harnessing mRNA to prevent and slow Alzheimer’s disease. 2025. At: https://florey.edu.au/news/2025/07/harnessing-mrna-to-prevent-and-slow-alzheimers-disease/
- He Q, Wang W, Zhang Y, et al. Global burden of young-onset dementia, from 1990 to 2021: an age-period-cohort analysis from the global burden of disease study 2021. Transl Psychiatry 2025. Epub 2025, 17 February.
- Ramanan VK, Armstrong MJ, Choudhury P, et al. Antiamyloid monoclonal antibody therapy for Alzheimer disease. Neurology 2023;101(19)842–52. At: www.neurology.org/doi/10.1212/WNL.0000000000207757
- World Health Organization. Dementia. 2025. At: www.who.int/en/news-room/fact-sheets/detail/dementia
- Mayo Clinic. Alzheimer’s disease. 2025. At: www.mayoclinic.org/diseases-conditions/alzheimers-disease/symptoms-causes/syc-20350447
- Eyting M, Xie M, Michalik F, et al. A natural experiment on the effect of herpes zoster vaccination on dementia. Nature 2025. Epub 2025 2 April. At www.nature.com/articles/s41586-025-08800-x
- Safety and efficacy of long-term gantenerumab treatment in dominantly inherited Alzheimer's disease: an open-label extension of the phase 2/3 multicentre, randomised, double-blind, placebo-controlled platform DIAN-TU trial. Bateman, Randall J et al. Lancet Neurology 2025; 24(4):316–30.
- Roche. Roche presents novel therapeutic and diagnostic advancements in Alzheimer’s at AP/PD 2025. 2025. At: www.roche.com/media/releases/med-cor-2025-04-03
- Burge K. Treatment to slow early Alzheimer’s gets TGA approval. newsGP 2025. At: www1.racgp.org.au/newsgp/clinical/treatment-to-slow-early-alzheimer-s-gets-tga-appro
- Promising results of new Alzheimer’s drug published – early diagnosis is key. 2023. At: www.dementia.org.au/media-centre/media-releases/promising-results-new-alzheimers-drug-published-early-diagnosis-key
- Victoria State Government. mRNA Victoria. Research. July 2025. At: https://djsir.vic.gov.au/mrna-victoria/research
- Sander N, Jull DA. Bridging the gap: how dementia support pharmacists are transforming care in rural South Australia. Issue 91. June 2, 2025. At: https://ruralhealth.org.au/partyline/bridging-the-gap-how-dementia-support-pharmacists-are-transforming-care-in-rural-south-australia/
- Stone H. To articulate a framework for the role of the palliative care pharmacist in community and aged care in Australia. Winston Churchill Trust 2025. At: www.churchilltrust.com.au/project/to-articulate-a-framework-for-the-role-of-palliative-care-pharmacist-in-community-and-aged-care-in-australia/
[post_title] => Advancing dementia care in pharmacy
[post_excerpt] => The various dementias are a huge cause of death in Australia. Despite some light on the horizon, there are still no effective treatments.
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[post_content] => Pharmacists are asked to lead the shift from reliever-only inhalers to inhaled corticosteroid-containing regimens and to minimise short courses of oral corticosteroids.
Just under 3 million Australians live with asthma. The condition has the eighth-highest disease burden in the nation, and it is one of the most significant chronic conditions in children.
Guided by the results of large trials, recommendations for asthma management in adults and adolescents are changing, and pharmacists need to be aware of updated guidelines. The Australian Asthma Handbook was updated yesterday (16 September 2025) to reflect new thinking on asthma care and management.
What are the key updates?
Three key changes have been made to the Australian Asthma Handbook, including:
-
- All adults and adolescents with confirmed asthma should be taking inhaled corticosteroid-containing treatment and not as-needed short-acting beta2-agonists (SABAs) alone. Asthma can be well controlled with maintenance and reliever therapy, and a small proportion of patients with severe asthma may be eligible for biologics.
- An emphasis on the importance of limiting oral corticosteroids, which have been associated with a range of different harms, including damage to bone health, cataracts and type 2 diabetes.
- Health professionals should be aware the handbook has greater guidance for treating children aged 1–5 who are living with asthma and a recommendation that some older children should also be on low-dosage ICS maintenance therapy.
Why have the guidelines been updated?
Overuse of SABAs has been linked to poor asthma control and preventable hospitalisations.
‘The evidence is that the risks of SABA alone have become clearer and that we were overusing a not very effective and not very safe therapy,’ said Professor Nick Zwar, Executive Dean of Bond University’s Faculty of Health Sciences and Medicine, and Chair of the Australian Asthma Handbook Guidelines Committee.
‘Budesonide-formoterol, taken only as needed, is recommended in place of SABA. Maintenance and reliever therapy is now recommended as the next step up.’
The risks of SABA overuse include a lack of bronchodilator response over time, and the possibility that some people may have quite a severe asthma attack and end up in the hospital emergency department (ED), or hospitalised, when they don’t need to be.
There is very strong evidence to demonstrate that all adolescents and adults living with asthma should be treated with ICS, said pharmacist and Clinical Executive Lead at the National Asthma Council Australia, Debbie Rigby FPS.
‘Just having the SABA alone only treats one component of asthma, which is the bronchoconstriction, whereas having the low-dose ICS helps manage the inflammation and mucus production,’ she said. ‘I think that’s the biggest shift for us, pharmacists and doctors: helping patients to understand that asthma is a chronic inflammatory condition.’
What are the risks of poor asthma control?
Inadequately managed asthma can be a life-threatening condition, Ms Rigby stressed, noting there were 474 asthma-related deaths in Australia in 2023.
‘Those deaths shouldn’t be happening. Many of those people who did die from asthma or asthma-related causes would have been perceived as having mild, intermittent symptoms,’ she said. ‘Without wanting to scare patients, we should be really highlighting the consequences of not having good control of their asthma.’
Why is SABA still overused?
Despite access to long-acting beta2 agonists (ICS–LABAs), SABA use remains high for a range of reasons. These include cost, convenience and patient reluctance to medicate every day when they are accustomed to using a reliever-only when they have an asthma attack, Ms Rigby said.
Health professionals understand that many people are reluctant to use a preventer inhaler, but health professionals need to help them understand that they have a ‘chronic inflammatory condition, which may flare up from time to time’.
Effects of the cost-of-living crisis should not be underestimated either. However, the price gap between over-the-counter salbutamol and prescription asthma medicines is now narrowing, with 60-day dispensing for patients who are stable and, from January 2026, the co-payment for medicines being reduced from $31.60 to $25 per prescription.
The Australian uptake of Maintenance and Reliever Therapy (MART) has also been slow, despite strong evidence and subsidy on the Pharmaceutical Benefits Scheme. The evidence of large-scale trials has shown the importance of shifting patients with mild asthma onto anti-inflammatory reliever therapy on an as-needed basis, Ms Rigby said.
‘The evidence basically says it reduces the risk of severe exacerbations requiring ED or hospitalisation, or requiring oral corticosteroids,’ she said.
For practical guidance on discussing the guideline changes with patients, the role of prescribing pharmacists, and how biologics fit into care, don’t miss the October cover story in Australian Pharmacist.
[post_title] => New asthma guidelines released
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[post_content] => Tomorrow (Thursday 25 September 2025) is World Pharmacists Day – an annual milestone for the past 16 years that celebrates the pharmacy profession worldwide and amplifies its essential contribution to health systems.
The theme for this year’s World Pharmacists Day, as chosen by the International Pharmaceutical Federation (FIP) is ‘Think Health, Think Pharmacist’.
The theme reflects the vital role of pharmacists both in Australia and internationally, and the need to routinely embed them across all areas of the health system.
Ahead of the day, FIP President, Australia’s Paul Sinclair AM MPS said ‘Think Health, Think Pharmacist’ is more than a campaign – it’s a call to action.
‘Pharmacists are crucial to the safe use of medicines, chronic disease management and public health delivery. Investing in them is investing in stronger health systems,’ he said.
‘As the world faces rising healthcare demands, economic uncertainty, and growing threats like antimicrobial resistance and climate change – pharmacists remain key to ensuring safe, cost-effective, and accessible care.
‘From improving health literacy and delivering vaccinations to ensuring the safe use of medicines, pharmacists are an indispensable part of our health systems, especially in underserved communities.’
Getting involved in World Pharmacists Day
Australian pharmacists can get involved by engaging patients, politicians and stakeholders in conversation. Pharmacists can also champion the profession through social media, including:
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[post_content] => As US regulators flag new warnings, the Therapeutic Goods Administration (TGA) and Australian experts have weighed in on what the evidence shows.
Paracetamol has widely been considered the safest analgesic to relieve fever and pain during pregnancy. Fever higher than 38.9°C for at least 24 hours during pregnancy is linked to higher chances of miscarriage, preterm birth, stillbirth and certain malformations including neural tube defects like spina bifida.
Yet the US Food and Drug Administration (FDA) announced it intends to add a warning label to the medicine, citing a ‘possible association’ between autism in children and the use of acetaminophen (paracetamol) during pregnancy.
This proposed regulation change, along with updated advice given to the American Academy of Pediatrics among other medical groups, follows an announcement from the US President linking acetaminophen (Tylenol) (known as paracetamol in Australia) to autism – calling on pregnant women to avoid it.
Australia’s Chief Medical Officer Micahel Kidd has rejected claims about the use of paracetamol in pregnancy and the risk of developing ADHD or autism. So what are other experts saying?
TGA: ‘safe for use in pregnancy’
Paracetamol remains Pregnancy Category A in Australia, meaning that it is considered safe for use in pregnancy, a spokesperson for the TGA told Australian Pharmacist.
‘The use of medications in pregnancy is subject to clinical, scientific and toxicological evaluation at the time of registration of a medicine in Australia,’ the spokesperson said.
‘Paracetamol has been taken by a large number of pregnant women and women of childbearing age without any proven increase in the frequency of malformations or other harmful effects on the fetus having been observed.’
Paracetamol is still the recommended treatment option for pain or fever in pregnant women when used as directed, the TGA said.
‘Importantly, untreated fever and pain can pose risks to the unborn baby, highlighting the importance of managing these symptoms with recommended treatment.
The spokesperson said that the TGA maintains robust post-market safety surveillance and pharmacovigilance processes for all medicines registered in Australia, including paracetamol.
‘When safety signals are identified for a medicine, they are subject to detailed clinical and scientific investigation to confirm that a safety issue exists, and if confirmed, what regulatory actions are most appropriate to mitigate the risk,’ the spokesperson said. ‘The TGA has no current active safety investigations for paracetamol and autism, or paracetamol and neurodevelopmental disorders more broadly.’
Australia is not the only nation holding firm; international peer regulators, such as the UK Medicines and Healthcare products Regulatory Agency, continue to advise that paracetamol be used according to the approved Product Information.
In its 2019 review, the European Medicines Agency also determined that the available evidence on paracetamol’s effects on childhood neurodevelopment is inconclusive.
Is there any evidence linking paracetamol in pregnancy with autism?
Some systematic reviews have reported associations between paracetamol use in pregnancy and autism in children – usually prolonged, high-dose use that exceeds recommendations.
Of central interest to the US Government's claim is a 2025 systematic review which made the claim of ‘strong evidence of a relationship between prenatal acetaminophen use and increased risk of ASD in children’.
But the quality of these studies have been subject to significant critical review.
Professor Margie Danchin, a paediatrician and group leader of the Murdoch Children’s Research Institute’s Vaccine Uptake Group, refuted the evidence base, made up of observational studies, linking paracetamol to autism.
‘The cause of fever for the women in those studies is probably what caused the problems later on developmentally for the children, not the fact that they took Panadol for that fever.’
Additionally, Prof Danchin said many of the women who participated in these studies were asked several years postpartum whether they took paracetamol during pregnancy, further undermining accuracy.
More recent and robust studies contradict these claims and support the prevailing evidence that paracetamol is not causally linked to autism or ADHD, the TGA said.
Experts point to a Swedish cohort study as the most persuasive evidence on paracetamol and autism. Published last year, it analysed records for nearly 2.5 million children born between 1995 and 2019, identifying autism diagnoses and verifying whether mothers used paracetamol during pregnancy.
Crucially, the investigators conducted a sibling-comparison analysis, assessing pairs in which one child was prenatally exposed to paracetamol and the other was not. Because siblings share much of their genetics, household environment and maternal health influences, this approach helps isolate the impact of specific factors such as paracetamol.
In the largest study of its kind to date, no association was found between prenatal paracetamol exposure and autism.
Imparting safe and accurate information
Prof Danchin called the claim linking acetaminophen exposure in utero to autism ‘disinformation’.
‘At the moment, the biggest issue at play is trust,’ she said.
The danger of ‘repeatedly repeating myths’ is that it further entrenches them.
‘That sort of repetition becomes very sticky. People hear it all the time, and it becomes harder and harder to counter,’ Prof Danchin said.
However, health professionals should ensure the right messages get across, she said.
When counselling patients on paracetamol use in pregnancy, PSA has advised pharmacists to take the following approach:
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[post_content] => A new report lays bare the impact of chronic pain in young people. During Kids in Pain Week (22–28 September), an expert shares practical steps for pharmacists to improve care.
Sydney-based Laura was just 10 years old when a bout of shingles left her with constant, debilitating pain. Laura went from being a fit and active middle sister to being unable to walk or move without a wheelchair at the age of 11, and completely reliant on her family for care. Doctors were stumped and investigations proved fruitless.
‘I was so sick of doctors – waiting for the doctors and waiting to do anything and just so ready to give up,’ Laura said.
[caption id="attachment_30566" align="aligncenter" width="500"] Laura with her mum Michelle[/caption]
When living with chronic pain, it’s easy to feel misunderstood and lonely, she shared.
‘Laura was having a really hard time, was depressed, barely talking and struggling. It was so hard to see her like that,’ Laura’s mum, Michelle said.
‘People underestimate how chronic pain may start as a physical issue but then becomes a mental health issue when everything is so uncertain and you aren’t sure if life will ever be what it was.’
Around one in five children aged 6–18 live with chronic pain, which equates to approximately 877,000 Australian kids – according to Australian Bureau of Statistics (ABS) data.
The inaugural Kids in Pain Report from Chronic Pain Australia shows how pain affects every aspect of these children’s lives, as well as their families, and the many who are likely unaccounted for, said pharmacist and Chronic Pain Australia chairperson, Nicolette Ellis MPS.
‘In 2019 the World Health Organization recommended that chronic pain be recognised as a condition in its own right and provided a way to capture that in healthcare data with ICD-11 coding,’ she said. ‘But chronic pain isn’t recognised as a condition in Australia; it’s recognised only as a symptom of an injury or another condition.’
[caption id="attachment_30564" align="aligncenter" width="500"] Nicolette Ellis MPS[/caption]
Without robust prevalence data, chronic pain will remain missing from national policy – including the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme, Ms Ellis warned.
‘That cascades down into service planning and investment, which is not currently matched to need,’ she said. ‘For example, Australia only has nine specialist paediatric pain clinics; Tasmania and the Northern Territory have none, so families often travel 4–6 hours for specialist appointments.’
What does chronic pain look like in children?
Most (71%) of children experience musculoskeletal pain, typically due to rheumatoid arthritis and autoimmune conditions as well as lower-back pain, knee pain and other joint pain. Migraine and headaches, abdominal pain, connective-tissue disorders, neuropathic pain and pelvic pain are also prominent.
‘Most children have overlapping conditions – for example, migraine with abdominal pain, or musculoskeletal and neuropathic pain – so it’s rarely a single tidy diagnosis,’ Ms Ellis said.
There is a high correlation between neurodivergence and pain, with almost three-quarters (72.9%) of children with chronic pain having at least one neurodivergent diagnosis.
‘Life can be more stressful for neurodivergent individuals, producing hormones that amplify pain signals,’ she said.
About 60% of children with chronic pain also identified as female.
‘Women and girls have denser nerve networks and different immune systems,’ Ms Ellis said. ‘Fluctuations in oestrogen can also increase pain signals, while testosterone tends to reduce them.’
Why is there such a long road to diagnosis?
For over 64% of children living with chronic pain, it took at least 3 years to receive a diagnosis.
‘Culturally, there’s a belief that persistent pain is an “older person’s condition”,’ Ms Ellis said. ‘So many children’s pain is dismissed.’
It’s often assumed there is another reason driving the symptoms.
‘Common explanations given to families are anxiety, a mental-health issue, “growing pains” that will resolve, or school avoidance,’ she said. ‘That invalidates the child and parent, and delays diagnosis.’
Children can face significant challenges navigating the healthcare system, getting answers, and accessing quality treatment, leading to cascading consequences.
‘Around 80% of children have a secondary mental health challenge, report sleep issues and forgo sport and similar activities,’ she said. ‘Over 80% miss school, about 1 day per week on average, with many finding the school system inflexible and invalidating, with pain dismissed or labelled as avoidance.’
Should a child experience ongoing, persistent pain, it should be taken ‘very seriously’ by health professionals – including pharmacists – with early intervention and thorough assessment ideally taking place within the first 3–6 months.
‘Early action reduces chronicity, helps build tools and confidence in self-management, and helps keep children in school and engaged socially,’ Ms Ellis said.
What’s the pharmacist’s role?
Parents reported that they often see their pharmacist first to discuss their child's pain condition. To expedite diagnosis and ensure appropriate care, Chronic Pain Australia has released a Pharmacist Guide which includes language tips for discussing pain with children, ways to explain pain, and what good pain management looks like.
‘Pharmacists should ask how long the pain has been present and validate that it’s challenging to live with,’ Ms Ellis said. ‘Emphasise the importance of seeing a local GP for assessment and early diagnosis.’
Other key language tips include using ‘lives with pain’ over ‘suffers from’. Pharmacists should also describe ‘bad” or ‘challenging’ days rather than ‘flare-ups’.
‘Link with local providers, such as occupational therapists, physiotherapists and psychologists – who understand different communication and treatment needs, including for neurodivergent children who may express pain differently,’ she said.
When addressing children with neurodivergence, pharmacists should inquire how best to communicate with them, what topics to avoid and what information would help.
‘Communication should always be age-appropriate and family-centred,’ Ms Ellis said. ‘The goal is to create a friendly, approachable environment where children feel comfortable sharing, while parents can help fill in the picture when needed.’
How should symptom management be approached?
Management approaches for chronic pain depend on the child, condition, and whether function improves, Ms Ellis said.
‘In paediatric pain medicine we try to avoid medicines and use them sparingly, but if a non-functional child becomes functional on a medicine that may restore quality of life – that should be central to pain management.’
Ms Ellis recalls an example of a 14-year-old girl prescribed an opioid to be taken before menstruation for 4–5 days. While some healthcare professionals were quick to label this approach an addiction risk, it perhaps kept her in school during severe periods while investigations took place for endometriosis or polycystic ovarian syndrome.
‘Pharmacists concerned about higher-risk medicines should focus conversations on functional benefit, asking “Is this improving your ability to do things?”’ she said. ‘If not, initiate a discussion about whether to continue therapy, given the potential harms.’
With her mum’s support and extensive physical therapies, Laura was able to walk into her first day of high school without a walking stick. While she has good and bad days and constant flare ups, there are wins along the way – such as being able to start carrying a backpack rather than relying on a roller case.
‘It’s an invisible disability with constant pain that isn’t linear – there are different levels and sensations all the time and that changes the way I approach daily life,’ Laura said.
‘[But] when mum said I will keep fighting for you – it was almost like a promise, and she’s always kept it.’
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[post_content] => The various dementias are a huge cause of death in Australia. Despite some light on the horizon, there are still no effective treatments. AP explores the latest in dementia research.
Dementia is the second leading cause of death in Australia.1 The number of people living with the disease is expected to increase substantially as the population ages, potentially straining health systems.2
Despite accelerated research, including trials of more advanced compounds and recent Victorian Government grants supporting mRNA-based projects, effective treatments remain elusive.3
According to Dementia Australia's Executive Director of Services, Advocacy and Research, Dr Kaele Stokes (she/her), an estimated 433,000 Australians are currently living with dementia, including 29,000 people living with younger-onset dementia (when symptoms emerge before age 65).1
While there have been important advances in pharmaceutical research in the dementia field in recent years, Dr Stokes says, new medicines to date have limited application, availability and efficacy, and they do not stop the progression of dementia.
It is important to ensure health systems support everyone living with dementia now, she adds, noting that the new medicines may not work for many people with the condition, particularly patients who have lived with dementia for some time.
‘We don’t have an approach here in Australia that focuses on the importance of brain health across the life course,’ she says.
‘While we’re good at picking up other diseases, such as cardiovascular disease or diabetes, and putting steps in place to ensure the risks of severity in those conditions are minimised, we don’t really have conversations about brain health in a healthcare setting.’
Diagnosing dementia for younger and older people
Dr Stokes says while diagnostic tools are improving, diagnosing dementia is still a complex process.
Dementia is still seen as an older person’s disease, she adds, and it can be difficult for a person in their 40s or 50s to receive a dementia diagnosis.
According to a 2025 study in Translational Psychiatry, young-onset dementia in people aged under 65 years globally increased substantially in prevalence and incidence between 1990 and 2021 compared with overall people with dementia – and with a higher burden on women.4 The three highest risk factors were smoking, high body mass index and high fasting plasma glucose levels, while population growth was the largest contributor to the significant increase.4
‘There’s still a real fear and stigma around wanting to talk about brain health or talking to a healthcare professional about concerns around changes in cognition,’ Dr Stokes says.
‘But actually there are lots of reasons why it’s important to do that. A mix of pharmacological and non-pharmacological interventions can make a difference to quality of life and reduce the stress that somebody might be experiencing.’
It is important for people to focus on modifiable risk factors, potentially reducing the risk of developing dementia by about 45% by avoiding smoking or drinking too much and by maintaining a healthy diet, exercising regulary, and ensuring hearing and vision problems are identified and dealt with, Dr Stokes says.
For those at later stages of their lives, it’s important to avoid social isolation and to keep the brain active, she adds.
‘Learning new things can be really important – stretching the brain, firing up the neurons, to keep your brain active.’
Pharmacological advances
Healthcare professionals have high hopes for the potential benefits of newly available monoclonal antibody treatments for Alzheimer’s disease.5
University of Melbourne and Florey Institute Professor of Dementia Research Colin Masters, widely recognised as a world expert in the field of neurodegenerative diseases, estimates there are about 100 compounds in the pharmaceutical pipeline presently that are progressing through the trial stages.
‘Better forms, more effective forms, are coming within the next couple of years,’ he declares. ‘We’ve got to learn how to use them and manage all the adverse effects as well.’ He is optimistic about the future of dementia treatments – potentially including a routine vaccination.
‘The writing is on the wall,’ he says. ‘If the passive immunotherapies work, then everyone will be working on an active vaccination program. In other words, at age 50 or whatever, you just run up to your primary care physician, they do a blood test, you’re on the pathway – you get a shot of peptide in your arm.’
The most promising drug now on the horizon is trontinemab, Prof Masters says. It's a reinvented form of the monoclonal antibody gantenerumab – a drug that didn’t make it to market because of a lack of efficacy. Even so, he adds, gantenerumab has been found effective for certain conditions. ‘We’ve been trialling it for nearly 10 years now,’ Prof Masters says, ‘and we published in Lancet Neurology9 [in June 2025] that in early-onset familial types of Alzheimer’s disease, gantenerumab in high doses was effective in pre-clinical disease in young individuals who are at 100% risk of developing Alzheimer’s disease.’ Trontinemab, he adds, is the natural successor to gantenerumab.
In April, Roche announced the results of a phase II trial of trontinemab delivered via the “Brainshuttle” system, which found ‘rapid and deep, dose-dependent reduction of amyloid plaques in the brain’.10 At the same time, Roche announced it would begin a phase III trial of the drug later this year.10
‘It’s the next generation; it’s a major advance,’ Prof Masters says, explaining that the bispecific molecule of trontinemab is designed to go straight across the blood-brain barrier, so doses of the drug can be far smaller.
‘It’s the first antibody designed to do this, and a lot of companies are copying it right now, because it works so well.’
According to data released from the Roche trials, trontinemab causes far fewer and less severe adverse effects than gantenerumab, he points out.
Other promising Alzheimer’s disease treatments include the monoclonal antibody donanemab. It is marketed as Kisunla by Eli Lilly, and in May 2025 it was approved by the Therapeutic Goods Administration.11
Lecanemab, marketed as Leqembi, has not yet been approved in Australia, but Prof Masters says full results of a pre-clinical trial are expected by the end of 2027 and he and his colleagues expect a positive result.
All these monoclonal antibody drugs are most effective in the early stages of Alzheimer’s disease, so early diagnosis is critical.12 In July this year, the Victorian Government also announced more than $537,000 in grants to two Florey researchers for two Alzheimer’s research projects.
These are aimed at treating and preventing the disease with mRNA technology, which was developed during the pandemic for COVID-19 vaccines.13
Pharmacist dementia support in the community
PSA’s Dementia Support Pharmacist Project in South Australia is an innovative project and model of practice aimed at keeping people with dementia at home and in the community for longer.14
Two pharmacists are employed on the project. They job-share to support clients with dementia medication management needs, understanding and choices, says South Australia and Northern Territory PSA Manager Helen Stone FPS (she/her).
The pharmacists act as patient advocates, provide flexible care for patients with complex comorbidities, and work with other members of the care team, including GPs, community pharmacists, nursing and care workers and families, she adds. Initial appointments are held in the patient's home, preferably with follow-ups either personally, by telephone or collaboration application such as MS Teams. A report prepared by the pharmacist is shared with the patient and, with consent, to treating medical and care teams, which may recommend an action plan to change or deprescribe medicines. Education about medicine use in dementia is also provided to health professionals and community groups across regional areas of the state.
‘This is a much-needed service; it is accessible, but there are a lot more people we can’t yet support,’ Ms Stone says. PSA has demonstrated that pharmacists working directly with patients and liaising with the care team can provide valuable support for patients with complex conditions and multimorbidities.
The project began in May 2024 and has been extended to June 2026. Ms Stone recently submitted a proposal to SA Health to expand the program and include a further five FTE pharmacists to cover metropolitan Adelaide.
Dementia care pharmacists can help with complex deprescribing of medicines and tapering of antidepressants where needed. They can provide professional advice to family members caring for patients with dementia that can empower carers as advocates in cases, for instance, of inadequate pain management.
Medicine administration frustrations can be avoided when dose time changes can be suggested.
Project pharmacist Dee-Anne Hull MPS (she/her) says pharmacist dementia support work helps in areas where it is needed most. ‘It has shown us where gaps in health care are in rural and remote areas of our state, but also within the pharmacy profession itself,’ she says. ‘A lot of pharmacists openly admit that dementia scares them, and they don’t really know where to start.
‘My advice is to make this an area of focus for CPD activities; check out the numerous PSA resources available, particularly those on palliative care and deprescribing, but also check out websites like Dementia Australia, Dementia Training Australia and the Wicking Dementia Centre,’ she adds.
‘Think about ways that you could support someone who is caring for a person living with dementia and the carer’s burden that may be associated with this, because that’s often where the support is needed the most.’
Positive response
Dementia Support Pharmacist Project pharmacist Nicola Sander MPS (she/her) says she has seen ‘overwhelming support and positive feedback’ for the project.
‘We have seen considerable benefit for people who are still living at home and are trying to manage their medicines.
Ms Sander sees this dementia support career pathway as ideal for an early career pharmacist and suggests that training in deprescribing and dementia-specific areas would be useful.
After a lengthy consultation with one client living at home, the client’s family and her doctor, Ms Sander recommended medicine management changes. The doctor was reluctant, so the client’s daughter found a doctor who was willing to be part of a multidisciplinary team, Ms Sander says, which included deprescribing strategies and pain support management.
After a recent visit to the geriatrician, the client’s daughter reported that her mother’s Mini‐Mental State Examination had improved from 12/30 to 19/30.
The daughter and the geriatrician attributed the client’s improvement to ‘better control of pain and overall improvement to her mood, as she has felt more supported and less depressed' since.
Ms Stone, whose Churchill Fellowship palliative care research – To articulate a framework for the role of Palliative Care Pharmacist in community and aged care in Australia – Churchill Trust15 – informed the Dementia Support Pharmacist Project, says that education, training and curiosity help pharmacists to start understanding dementia care more fully.
She encourages everyone to complete a Program of Experience in the Palliative Approach (PEPA) placement.
‘A dementia diagnosis can be devastating for people and their families; medications can have a benefit but can also impair cognition, so support from a pharmacist can be very valuable.'
References
- Australian Institute of Health and Welfare. Dementia In Australia. 2024. At: www.aihw.gov.au/reports/dementia/dementia-in-aus/contents/population-health-impacts-of-dementia/deaths-due-to-dementia
- Dementia Australia. Dementia facts and figures. 2024. At: www.dementia.org.au/about-dementia/dementia-facts-and-figures
- Florey Institute for Neuroscience and Mental Health. Harnessing mRNA to prevent and slow Alzheimer’s disease. 2025. At: https://florey.edu.au/news/2025/07/harnessing-mrna-to-prevent-and-slow-alzheimers-disease/
- He Q, Wang W, Zhang Y, et al. Global burden of young-onset dementia, from 1990 to 2021: an age-period-cohort analysis from the global burden of disease study 2021. Transl Psychiatry 2025. Epub 2025, 17 February.
- Ramanan VK, Armstrong MJ, Choudhury P, et al. Antiamyloid monoclonal antibody therapy for Alzheimer disease. Neurology 2023;101(19)842–52. At: www.neurology.org/doi/10.1212/WNL.0000000000207757
- World Health Organization. Dementia. 2025. At: www.who.int/en/news-room/fact-sheets/detail/dementia
- Mayo Clinic. Alzheimer’s disease. 2025. At: www.mayoclinic.org/diseases-conditions/alzheimers-disease/symptoms-causes/syc-20350447
- Eyting M, Xie M, Michalik F, et al. A natural experiment on the effect of herpes zoster vaccination on dementia. Nature 2025. Epub 2025 2 April. At www.nature.com/articles/s41586-025-08800-x
- Safety and efficacy of long-term gantenerumab treatment in dominantly inherited Alzheimer's disease: an open-label extension of the phase 2/3 multicentre, randomised, double-blind, placebo-controlled platform DIAN-TU trial. Bateman, Randall J et al. Lancet Neurology 2025; 24(4):316–30.
- Roche. Roche presents novel therapeutic and diagnostic advancements in Alzheimer’s at AP/PD 2025. 2025. At: www.roche.com/media/releases/med-cor-2025-04-03
- Burge K. Treatment to slow early Alzheimer’s gets TGA approval. newsGP 2025. At: www1.racgp.org.au/newsgp/clinical/treatment-to-slow-early-alzheimer-s-gets-tga-appro
- Promising results of new Alzheimer’s drug published – early diagnosis is key. 2023. At: www.dementia.org.au/media-centre/media-releases/promising-results-new-alzheimers-drug-published-early-diagnosis-key
- Victoria State Government. mRNA Victoria. Research. July 2025. At: https://djsir.vic.gov.au/mrna-victoria/research
- Sander N, Jull DA. Bridging the gap: how dementia support pharmacists are transforming care in rural South Australia. Issue 91. June 2, 2025. At: https://ruralhealth.org.au/partyline/bridging-the-gap-how-dementia-support-pharmacists-are-transforming-care-in-rural-south-australia/
- Stone H. To articulate a framework for the role of the palliative care pharmacist in community and aged care in Australia. Winston Churchill Trust 2025. At: www.churchilltrust.com.au/project/to-articulate-a-framework-for-the-role-of-palliative-care-pharmacist-in-community-and-aged-care-in-australia/
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[post_content] => Pharmacists are asked to lead the shift from reliever-only inhalers to inhaled corticosteroid-containing regimens and to minimise short courses of oral corticosteroids.
Just under 3 million Australians live with asthma. The condition has the eighth-highest disease burden in the nation, and it is one of the most significant chronic conditions in children.
Guided by the results of large trials, recommendations for asthma management in adults and adolescents are changing, and pharmacists need to be aware of updated guidelines. The Australian Asthma Handbook was updated yesterday (16 September 2025) to reflect new thinking on asthma care and management.
What are the key updates?
Three key changes have been made to the Australian Asthma Handbook, including:
-
- All adults and adolescents with confirmed asthma should be taking inhaled corticosteroid-containing treatment and not as-needed short-acting beta2-agonists (SABAs) alone. Asthma can be well controlled with maintenance and reliever therapy, and a small proportion of patients with severe asthma may be eligible for biologics.
- An emphasis on the importance of limiting oral corticosteroids, which have been associated with a range of different harms, including damage to bone health, cataracts and type 2 diabetes.
- Health professionals should be aware the handbook has greater guidance for treating children aged 1–5 who are living with asthma and a recommendation that some older children should also be on low-dosage ICS maintenance therapy.
Why have the guidelines been updated?
Overuse of SABAs has been linked to poor asthma control and preventable hospitalisations.
‘The evidence is that the risks of SABA alone have become clearer and that we were overusing a not very effective and not very safe therapy,’ said Professor Nick Zwar, Executive Dean of Bond University’s Faculty of Health Sciences and Medicine, and Chair of the Australian Asthma Handbook Guidelines Committee.
‘Budesonide-formoterol, taken only as needed, is recommended in place of SABA. Maintenance and reliever therapy is now recommended as the next step up.’
The risks of SABA overuse include a lack of bronchodilator response over time, and the possibility that some people may have quite a severe asthma attack and end up in the hospital emergency department (ED), or hospitalised, when they don’t need to be.
There is very strong evidence to demonstrate that all adolescents and adults living with asthma should be treated with ICS, said pharmacist and Clinical Executive Lead at the National Asthma Council Australia, Debbie Rigby FPS.
‘Just having the SABA alone only treats one component of asthma, which is the bronchoconstriction, whereas having the low-dose ICS helps manage the inflammation and mucus production,’ she said. ‘I think that’s the biggest shift for us, pharmacists and doctors: helping patients to understand that asthma is a chronic inflammatory condition.’
What are the risks of poor asthma control?
Inadequately managed asthma can be a life-threatening condition, Ms Rigby stressed, noting there were 474 asthma-related deaths in Australia in 2023.
‘Those deaths shouldn’t be happening. Many of those people who did die from asthma or asthma-related causes would have been perceived as having mild, intermittent symptoms,’ she said. ‘Without wanting to scare patients, we should be really highlighting the consequences of not having good control of their asthma.’
Why is SABA still overused?
Despite access to long-acting beta2 agonists (ICS–LABAs), SABA use remains high for a range of reasons. These include cost, convenience and patient reluctance to medicate every day when they are accustomed to using a reliever-only when they have an asthma attack, Ms Rigby said.
Health professionals understand that many people are reluctant to use a preventer inhaler, but health professionals need to help them understand that they have a ‘chronic inflammatory condition, which may flare up from time to time’.
Effects of the cost-of-living crisis should not be underestimated either. However, the price gap between over-the-counter salbutamol and prescription asthma medicines is now narrowing, with 60-day dispensing for patients who are stable and, from January 2026, the co-payment for medicines being reduced from $31.60 to $25 per prescription.
The Australian uptake of Maintenance and Reliever Therapy (MART) has also been slow, despite strong evidence and subsidy on the Pharmaceutical Benefits Scheme. The evidence of large-scale trials has shown the importance of shifting patients with mild asthma onto anti-inflammatory reliever therapy on an as-needed basis, Ms Rigby said.
‘The evidence basically says it reduces the risk of severe exacerbations requiring ED or hospitalisation, or requiring oral corticosteroids,’ she said.
For practical guidance on discussing the guideline changes with patients, the role of prescribing pharmacists, and how biologics fit into care, don’t miss the October cover story in Australian Pharmacist.
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Australian Pharmacist is the official journal for Pharmaceutical Society of Australia Ltd.
