This Practice Alert highlights some recent practice issues reported to PDL Professional Officers.
Respiratory Syncytial Virus (RSV) vaccines
Currently, two Respiratory Syncytial Virus (RSV) vaccines, Arexvy® and Abrysvo®, have been approved by the Therapeutic Goods Administration (TGA) for protecting adults against RSV disease. Recent government-led vaccination campaigns have highlighted the benefits of immunisation against RSV infection, resulting in increased patient uptake of these vaccines.
A single dose of Arexvy or Abrysvo is recommended for:
- People aged 75 years and over
- First Nations people aged 60 years and over
- Adults aged 60 years and over with conditions that increase their risk of severe RSV disease
A single dose of Abrysvo is recommended for pregnant women at 28-36 weeks gestation to protect the infant via passive immunisation, as per guidance in the Australian Immunisation Handbook.
Pharmacists are reminded to check the age range of a patient when supplying and/or administering a RSV vaccine, in addition to adhering to relevant state and territory legislation. For younger patients, it is recommended to check pregnancy status prior to vaccine supply. Abrysvo is the only RSV vaccine approved for use in pregnancy, as indicated in the Australian Immunisation Handbook.
Awareness of the approved indications for these two vaccines can ensure the appropriate vaccine is administered to the patient.
Midazolam strength confusion
Midazolam is a commonly administered medicine in palliative care and has an important role in ensuring quality care for palliative patients. The Australian Register of Therapeutic Goods lists midazolam ampoules in different concentrations, including 5mg/mL and 5mg/5mL. The higher concentration (5mg/mL) midazolam is often preferred for patients receiving palliative care, as a smaller volume of solution is beneficial for the patient’s care and the nurse administering the dose.
The Professional Officers would like to raise awareness of the different concentrations available and encourage pharmacists to consider stocking the higher concentration if they have patients receiving palliative care. Immediate availability of the higher concentration product can prevent delays in treatment for these patients with urgent needs.
Pharmacists are reminded to carefully check the concentration of midazolam ampoules at the time of dispensing to ensure the prescribed concentration is always provided, preventing interruptions in the supply for patients in palliative care settings.
Semaglutide (Wegovy)
The Professional Officers continue to receive incident reports involving the supply of incorrect strengths of the Wegovy FlexTouch products. In some cases, this has resulted in patients administering higher than prescribed doses of semaglutide causing adverse effects. In a very small number of cases, the sudden onset of abdominal symptoms has led patients to present at Emergency Departments. Acute kidney injury in patients who have received high semaglutide doses has been reported to the Professional Officers.
The recent PDL Practice Alert ‘Confusion with Wegovy (semaglutide) prescriptions’ offers guidance for pharmacists on reducing risks when dispensing and supplying Wegovy, and highlights concerns for patients who use the “click method” for dosing.
For immediate advice and incident support, call PDL on 1300 854 838 to speak to one of our Professional Officers. We are here to support our pharmacist members 24/7, Australia-wide.
