No more cilazapril please: Pharmac starts phase-out in May
This story was originally published in Pharmacy Today|Kaitiaki Rongoā o te Wā and is republished with permission.
“We know that changing the schedule in this way may create additional work for you [pharmacists]. This is currently the main lever we have to change prescribing behaviour. We appreciate you and the work you do”
Pharmac is asking prescribers to stop prescribing one of New Zealand’s most widely used blood pressure medications and attempt to move patients to alternatives.
In a notice published last week, Pharmac advised prescribers that from 1 May they should not prescribe the ACE inhibitor cilazapril to any new patients.
About 210,000 people are already taking the drug, which is currently supplied through a sole-supply contract for the Zapril brand which lasts until June 2022.
Patients can continue using it after May but prescribers are advised to consider switching patients to other drugs. A range of other ACE inhibitors and angiotensin II antagonists are also funded in New Zealand.
Response to supply issues
In an emailed response, Pharmac director of operations Lisa Williams says the advisory was issued to reduce New Zealand’s future vulnerability to supply shortages.
New Zealand is the only country that uses cilazapril in large quantities, Ms Williams says, and the active ingredient for the drug is manufactured in only one location in the world – Hetero Labs in India.
“If there were a manufacturing issue (including if global demand reduced) and that affected supply to New Zealand, it would be impossible for us to find enough cilazapril for everyone who takes it.”
She is confident the terms of the current sole-supply contract ensure supply will be maintained, as long as there are no further interruptions to the global supply chain.
How pharmacists are affected
Pharmac will apply a Pharmaceutical Schedule endorsement “for existing cilazapril patients only” from:
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1 April 2021 – Section H
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1 May 2021 – Section B
Pharmacists can annotate the prescription as endorsed where there exists a record of prior dispensing of cilazapril.
The endorsement affects all three presentations of cilazapril (Zapril):
“We know that changing the schedule in this way may create additional work for you [pharmacists]. This is currently the main lever we have to change prescribing behaviour. We appreciate you and the work you do,” the notice announcing the change says.