Bay Navigator

Clinical Matters Newsletter May 2024

In this issue:

Discontinuation: Triazolam tablets 125mcg and 250 mcg

The supplier of triazolam 125 and 250 mcg tablets (Hypam) has advised Pharmac that they can no longer supply this medicine to the New Zealand market. Both strengths will be delisted once any remaining stock has been dispensed.

Key information:

  • Ensure no new patients are started on triazolam tablets
  • Consider whether benzodiazepines remain clinically indicated for your patients using triazolam
  • Support patients who are currently using triazolam to withdraw gradually or change to an alternative treatment if stopping is not appropriate.

Our clinical advisors suggest that for the majority of patients using triazolam, it will be appropriate to recommend gradual dose reduction as able, aiming for a complete drug withdrawal. For those for whom this is not appropriate, or if withdrawing fails, there are alternative funded medicines listed on the Pharmaceutical Schedule that could be considered, most likely temazepam or zopiclone.

Resources for healthcare professionals:


Further information is available in the Triazolam 125 and 250 mcg tablets (Hypam) notice.

Morphine liquid update: Oramorph


Health NZ memo dated 29 April 2024 regarding Oramorph


Pertussis update for Bay of Plenty and Lakes Districts

Health NZ Pertussis update BOP and Lakes District Page 1


Change to B12 and Folate Requesting

Notification from Pathlab regarding a change to B12 & Folate Requesting

Outbreak of dengue fever in Samoa

There is currently a significant outbreak of dengue fever in Samoa. Please remain vigilant for recent travellers who may present with symptoms.

For those who have patients who may be travelling to Samoa, the attached advice is also available to share.

We encourage you to share this email with your networks.

Transmission of dengue fever

Dengue fever is not spread from person to person. A person becomes infected with the dengue virus after being bitten by an infected mosquito.

Symptoms of dengue

While many people with dengue do not have symptoms, or only feel mildly unwell, some may experience the following symptoms:

  • sudden onset of fever
  • headache, particularly retro orbital
  • myalgia and arthralgia
  • a fine rash, which may be itchy, usually begins on the extremities, but spares the palms and soles of the feet
  • weakness
  • depression
  • anorexia
  • abnormal taste
  • sore throat
  • coughing
  • vomiting
  • abdominal pain

Symptoms usually start 3 to 14 days after being bitten by an infected mosquito. They can last from 2 to 7 days.

Warning signs of severe dengue

A small number of people may get severe dengue within 2 to 5 days of their symptoms starting. This is more likely to occur the second time a person is infected with dengue, when it may constitute dengue haemorrhagic fever. Warning signs include:

  • severe abdominal pain
  • mucosal bleeding
  • liver enlargement
  • fluid accumulation
  • persistent vomiting

People with severe dengue symptoms should be referred to hospital for management of haemorrhagic manifestations and possible hypovolaemic shock.

Management of dengue

Please follow HealthPathways advice for Fever in Returning Travellers.

Laboratory testing involves full blood count (leucopenia, thrombocytopenia, elevated ALT, increased HCT), and testing for the dengue virus (PCR) or antigen and/or serology tests.

Treatment is supportive, but NSAIDS (ibuprofen/aspirin) should be avoided. Seek infectious diseases advice if concerned, including if your patient has previously had dengue or there are any signs of bleeding.

Public health management: no isolation is required. Notification should be made to the local medical officer of health on suspicion.

Advice for patients travelling to Samoa

  • Please advise travellers to Samoa to protect themselves from mosquito bites when they are in Samoa, and to contact their GP or Healthline if they develop a fever or other symptoms after their return to New Zealand.
  • If travellers develop symptoms while in Samoa, they may need to seek healthcare locally.
  • Encourage them to check the latest public health advice – further information about dengue is available here and guidance on how to stay healthy when travelling is available here.
  • Additional safe travel advice for those travelling to Samoa.
  • We thank you for your support with the management of the implications of the dengue outbreak in Samoa and the distribution of this important information.

Ngā mihi,

National Clinical Team | Protection | National Public Health Service

New Community HealthPathways

Recent new localised pathways:


Dr Katrina Sandford, Dr Dan Jackson, and Dr Paula Taylor

Bay Navigator Team

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