PHARMAC – Supply of cilazapril with hydrochlorothiazide

Supply of cilazapril with hydrochlorothiazide Medicines (/medicines/)

Cilazapril with hydrochlorothiazide is a medicine used for the treatment of patients with hypertension who are not adequately controlled on monotherapy.

This medicine may also be used for other indications.

How medicines are funded (/medicines/how-medicines-are-funded/)

Medicines information (/medicines/medicines-information/)

My medicine or medical device has changed (/medicines/my-medicine-haschanged/)

Buprenorphine with naloxone

What's changing?

Apotex, the supplier of cilazapril with hydrochlorothiazide has informed PHARMAC it will no longer be able to supply this medicine in New Zealand. The current supply is likely to run out in July 2020.

Apo-Cilazapril/Hydrochlorothiazide is the only Medsafe registered brand of cilazapril with hydrochlorothiazide tablets in New Zealand. This means cilazapril with hydrochlorothiazide will no longer be available to patients once the current supply runs out. New patient initiations will be restricted.

Please note that this discontinuation does not apply to cilazapril tablets without hydrochlorothiazide.

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Cilazapril (/medicines/my-medicinehas-changed/cilazapril/)

Cilazapril with hydrochlorothiazide Diabetes meters (/medicines/mymedicine-has-changed/diabetesmeters/)

Flecainide (/medicines/my-medicine-

The future of cilazapril Supplies of cilazapril tablets have been secured until 2022. Cilazapril is used infrequently or not at all in other countries and we are aware of only one manufacturer of the active ingredient internationally.

This means if a supply issue were to occur, then it would likely be difficult to resolve or mitigate. This could have a significant impact on patients and health care professionals.

When prescribing an ACE inhibitor, consider prescribing a different one than cilazapril. > Check the schedule for all funded ACE inhibitors(external link) (https://www.pharmac.govt.nz/wwwtrs/ScheduleOnline.php?code=A0707)

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Fluoxetine - upcoming change of brand (/medicines/my-medicine-has-

When will cilazapril with hydrochlorothiazide be unavailable?

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Gaucher disease treatment (/medicines/my-medicine-has-

From 1 March 2020, cilazapril with hydrochlorothiazide will no longer be funded for new patients.

From July 2020, current cilazapril with hydrochlorothiazide stocks are likely to run out.

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Haemophilia treatments (/medicines/my-medicine-haschanged/haemophilia/)

Pharmacists may annotate the prescription as endorsed where there exists a record of prior dispensing of cilazapril with hydrochlorothiazide.

People taking cilazapril with hydrochlorothiazide will need to talk to their health care professional about alternative treatments.

Open al

Hepatitis C (Hep C) treatments (/medicines/my-medicine-haschanged/hepatitis-c-hep-c-treatments/)

Insulin pumps (/medicines/my-

Information for health care professionals

medicine-has-changed/insulin-pumps/)

(https://www.pharmac.govt.nz/medicines/my-medicine-has-changed/discontinuation-of-cilazapril-with-

Lamotrigine (/medicines/my-

hydrochlorothiazide/#information-for-health-care-professionals)

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Prescribers will need to:

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Lithium carbonate (/medicines/mymedicine-has-changed/lithium-

ensure no new patients are started on cilazapril with hydrochlorothiazide from 1 March 2020. start transitioning patients currently on cilazapril with hydrochlorothiazide to alternative treatments.

carbonate/)

MS treatments (/medicines/mymedicine-has-changed/ms-treatments/)

Nitrazepam (/medicines/mymedicine-has-changed/nitrazepam-

What are the funded treatment options?

Based on advice we have received from our expert clinical advisors, alternative treatment options for cilazapril with hydrochlorothiazide include:

nitrados/)

A suitable fully funded alternative angiotensin II antagonist with diuretic would be losartan with hydrochlorothiazide

Oxycodone (/medicines/my-medicine-

A suitable fully funded alternative ACE inhibitor with diuretic would be quinapril with hydrochlorothiazide

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Paroxetine (/medicines/my-medicinehas-changed/paroxetine/)

Agent

Rivastigmine (/medicines/my-

Cilazapril with hydrochlorothiazide (Apo-Cilazapril/ Hydrochlorothiazide)

medicine-has-changed/generic-

Quinapril with hydrochlorothiazide

Losartan with hydrochlorothiazide (Arrow-Losartan & Hydrochlorothiazide)

(Accuretic)

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Sertraline (/medicines/my-medicinehas-changed/sertraline/)

Approximate Equivalent Strength

5 mg cilazapril with

20 mg* (/medicines/my-

12.5 mg hydrochlorothiazide

Your health (/medicines/your-health/)

medicine-haschanged/discontinuation-ofcilazapril-with-

50 mg losartan with 12.5 mg hydrochlorothiazide1 (/medicines/my-medicine-haschanged/discontinuation-of-cilazapril-with-hydrochlorothiazide/#FN1)

hydrochlorothiazide/#asterisk)

Hospital pharmaceuticals (/tools-

quinapril with

resources/pharmaceutical-schedule/section-h/)

12.5 mg hydrochlorothiazide1

New medicines (/medicines/new-medicines/)

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Equity (/medicines/equity/)

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Indication

For the treatment of hypertension not adequately controlled with monotherapy

Dosing Regimen 2

5 mg/12.5 mg once daily2 (/medicines/my-medicine-haschanged/discontinuation-of-cilazapril-withhydrochlorothiazide/#FN2)

Initially one 10/12.5 mg tablet daily, increased to 20/12.5 mg daily if necessary (/medicines/my-

Initially one 50/12.5 mg tablet once daily to a maximum 2 tablets (i.e. 100 /25 mg) once daily4 (/medicines/my-medicine-haschanged/discontinuation-of-cilazapril-with-hydrochlorothiazide/#FN4)

medicine-haschanged/discontinuation-ofcilazapril-withhydrochlorothiazide/#FN3)3 (/medicines/my-medicine-haschanged/discontinuation-of-cilazapril-withhydrochlorothiazide/#FN3)

* Quinapril with hydrochlorothiazide is also available in a 10 mg with 12.5 mg preparation

When changing patients to another fixed dose combination it is recommended to monitor blood pressure and renal function (creatinine and electrolytes

A fixed dose combination would be the preferred alternative to cilazapril with hydrochlorothiazide, although some people may prefer to change to two separate medicines (i.e. an ACE inhibitor and a separate diuretic). Currently cilazapril is used infrequently or not at all in other countries and we are awar of only one manufacturer of the active ingredient internationally. For this reason, alternative treatment agents should be considered. There are a numbe of different funded ACE inhibitors and one of these could be prescribed together with a funded thiazide or thiazide-like diuretic.

1. Table of subsidised ACE inhibitors, available tablet strength and recommended doses – BPAC NZ Website(external link) (https://bpac.org.nz/2018/ace.aspx#tab1)

2. NZ Formulary listing for cilazapril + hydrochlorothiazide(external link) (https://nzf.org.nz/nzf_10061) 3. NZ Formulary listing for quinapril + hydrochlorothiazide(external link) (https://nzf.org.nz/nzf_10062) 4. NZ Formulary listing for losartan + hydrochlorothiazide(external link) (https://nzf.org.nz/nzf_10090)

Information for people taking cilazapril with hydrochlorothiazide (https://www.pharmac.govt.nz/medicines/my-medicine-has-changed/discontinuation-of-cilazapril-withhydrochlorothiazide/#information-for-people-taking-cilazapril-with-hydrochlorothiazide-) Cilazapril with hydrochlorothiazide is used to treat people with high blood pressure and may also be used for other conditions.

What's changing The supplier of cilazapril with hydrochlorothiazide (Apotex) has informed PHARMAC it will no longer be able to supply this medicine in New Zealand. The current supply is likely to run out in July 2020.

No other brands of this medication are available, you will need to change to a different ACE inhibitor once the current supply runs out.

If you take cilazapril with hydrochlorothiazide, talk to your health care professional about alternative treatments.

Feedback

When will this happen We expect stocks to run out by July 2020. We recommend you talk to your health care professional before this to manage your move to a different medicine.

From 1 March 2020, new patients will not be funded for cilazapril with hydrochlorothiazide.

What are the funded treatment options?

There are a number of fully funded treatment options. You will need to talk to your health care professional to find out which is best for you.

Who to contact If you have any questions, contact PHARMAC on: 0800 660 050(external link) (http://tel:0800660050) enquiry@pharmac.govt.nz (mailto:Enquiry@pharmac.govt.nz?subject=Cilazapril%20with%20hydrochlorothiazide) Last updated: 24 January 2020

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