Revised: 20 June 2013
Committees
AGENDA FOR THE 27th MEETING
OF THE MEDICINES CLASSIFICATION COMMITTEE
TO BE HELD ON 23 MAY 2002
IN THE MEDSAFE MEETING ROOMS, 18th FLOOR, GRAND PLIMMER TOWER,
WELLINGTON
COMMENCING AT 9.30am
1. |
Welcome |
||||||
2. |
Apologies |
||||||
3. |
Confirmation of the Minutes of the 26th Meeting |
||||||
4. |
Declaration of Conflicts of Interest |
||||||
5. |
Matters Ariding from the 26th Meeting |
||||||
5.1 |
Objections to recommendations made at the 26th meeting |
||||||
5.2.1 |
BelladonnaWeleda submission deferred from the last meeting. To be discussed in conjunction with the harmonisation of solanaceous plants and alkaloids (see item 8.2.4, Recommendations to the MCC from the Australian National Drugs and Poisons Schedule Committee (NDPSC) in November 2001) |
||||||
5.2.2 |
Hyoscine, hyoscyamine, hyoscyamusWeleda submissions deferred from the last meeting. To be discussed in conjunction with the harmonisation of solanaceous plants and alkaloids (see item 8.2.4, Recommendations to the MCC from the NDPSC in November 2001) |
||||||
5.2.3 |
ProchlorperazineThe only OTC pack of buccal prochlorperazine has been discontinued. This means that pharmacists can no longer sell prochlorperazine for the relief of nausea associated with migraine because of the requirement in the Schedule for the product to be sold only in the manufacturer's original pack appropriately labelled for that indication. The Committee wishes to discuss whether this requirement should be removed from the schedule so that pharmacists can still sell prochlorperazine for nausea associated with migraine. The Committee will also discuss whether or not the prochlorperazine entry should be amended to allow the medicine to be sold by appropriately accredited pharmacists and nurses in conjunction with the emergency contraceptive pill. |
||||||
5.2.4 |
SabadillaWeleda response to discussion from the previous meeting. |
||||||
6. |
Submissions for Reclassification |
||||||
6.1 |
Minoxidil 2% topical solution (Headway, Pacific)A company submission for reclassification from restricted medicine
to pharmacy-only medicine. |
||||||
6.2 |
Aciclovir cream (Zovirax, GlaxoWellcome)A company submission for the reclassification of aciclovir cream
for the treatment of herpes labialis from pharmacy-only medicine
to general sale medicine. |
||||||
6.3 |
Salicylic acidA submission on behalf of SSL New Zealand Ltd for a change to the upper limit for sale as general sale medicine from 12.5% to 40% in order to harmonise with Australia. (see 8.1.4 below) |
||||||
7. |
New Medicines for Classification |
||||||
8. |
Harmonisation of New Zealand and Australian Schedules |
||||||
8.1 |
Outstanding harmonisation issues |
||||||
8.1.1 |
InsulinsNew Zealand and Australia have not yet harmonised on the classification of these. While there does not yet appear to have been a formal recommendation from the NDPSC, Medsafe was in favour of reclassifying insulins from restricted medicine to prescription medicine in order to harmonise. |
||||||
8.1.2 |
Dicyclomine and propanthelineThese two medicines have been omitted from earlier NDPSC recommendations for anticholinergics to become prescription medicines. There are products registered in New Zealand which contained these medicines. |
||||||
8.1.3 |
EphedraClassification from pharmacy-only to prescription medicine for consistency with ephedrine. There are no medicines registered in New Zealand which contain ephedra. |
||||||
8.1.4 |
Salicylic acidReclassify to general sale for dermal use in medicines containing 40% or less and to restricted medicine for dermal use in medicines containing more than 40%. Omitted from the February 2001 meeting of NDPSC. MCC had agreed in May 2000 to a 40% cut-off level for general sale and had been waiting for a formal recommendation from the NDPSC (see also item 6.3 above). |
||||||
8.2. |
Recommendations made by the NDPSC to the MCC in February 2001 |
||||||
8.2.1. |
DextromethorphanChange the pharmacy-only entry to: Dextromethorphan in packs containing 600 mg or less of dextromethorphan:
The classification of dextromethorphan was changed in 2000 to in order to harmonise. The further recommendation is based on a history of substance abuse of all dose forms. The recommendation would result in a change to the classification of all products which are currently available for general sale. Companies objecting to the change need to demonstrate that the product could not be readily abused. |
||||||
8.2.2 |
Atropine methonitrateMake a separate prescription medicine entry. Exclude atropine methonitrate from the pharmacy-only entry for atropine. If atropine methonitrate is listed separately as a prescription medicine there is no need to exclude it in the atropine entry in the New Zealand schedule. There are no medicines registered in New Zealand containing atropine methonitrate. |
||||||
8.2.3. |
HomatropineReclassify as prescription medicine for all strengths and dose forms. There would be no regulatory impact as New Zealand has only prescription products. |
||||||
8.2.4. |
Hysoscine butylbromideAdopt the following pharmacy-only entry:
To date the MCC has recommended against harmonisation for Buscopan tablets which are restricted medicine in New Zealand (see also recommendation in November 2001, agenda item 8.5.5). No other products would be affected. |
||||||
8.2.5 |
Mandragora officinarumAdd to the schedule as a prescription medicine. |
||||||
8.2.6 |
Digoxin-specific antibody fragmentAdd to the schedule as a prescription medicine. Medsafe had earlier queried the accuracy of a recommendation for a prescription medicine entry for digoxin antibody. The NDPSC has now responded with a recommendation for a more acceptable name. |
||||||
8.2.7 |
DextrorphanAdd to the schedule as a prescription medicine There are no products registered in New Zealand containing dextrorphan, a metabolite of dextromethorphan. |
||||||
8.2.8 |
Ion exchange resinsDelete the prescription medicine generic entry. A generic entry is unnecessary as ion exchange resins should be scheduled separately by name. |
||||||
8.2.9 |
Colestyramine resinReclassify from restricted medicine to prescription medicine as colestyramine on the grounds that the primary indications for this medicine do not meet the requirements for sale as a restricted medicine. Two Questran products would be affected by the change. |
||||||
8.2.10 |
Glatiramer acetateAdd to the schedule as a prescription medicine. Glatiramer acetate is included in the SUSDP but not the New Zealand schedule. |
||||||
8.2.11 |
AcepromazineAdd to the schedule as a prescription medicine. Acepromazine is included in the SUSDP but not the New Zealand schedule |
||||||
8.2.12 |
ThiomesteroneAdd to the schedule as a prescription medicine. This is an androgenic steroid. There is no reference to it in Martindale. |
||||||
8.2.13 |
Local anaestheticsAdd the following to the schedule as prescription medicines:
There is no reference to the first or last of these in Martindale which suggests that they may be obsolete and should be removed from the schedules. |
||||||
8.2.14 |
AmethocaineThe scheduling of amethocaine should be as follows:
New Zealand would retain the exemption from prescription status allowing optometrists to use eye preparations. |
||||||
8.2.15 |
BenzamineAdd to the New Zealand schedule as a prescription medicine on the grounds of harmonisation. As this substance is not scheduled in New Zealand, has no reference in Martindale and there are no products in either country, it may be a suitable candidate for removal from the schedules. |
||||||
8.2.16 |
BenzocaineThe scheduling of benzocaine should be as follows:
|
||||||
8.2.17 |
Butyl aminobenzoateAdd to the schedule as a prescription medicine. There are no medicines registered in either country containing this ingredient. |
||||||
8.2.18 |
CinchocaineThe scheduling of cinchocaine should be as follows:
|
||||||
8.2.19 |
Dimethisoquin and pramoxineAdd to the New Zealand schedule as prescription medicines. Pramoxine is already in the New Zealand schedule under its INN, pramocaine. It appears to be used only externally. Its classification is general sale at 2% or less and pharmacy-only above that concentration. As there are no longer any medicines available in New Zealand containing pramocaine, the recommendation would have no regulatory effect. Dimethisoquin is the BANM and USAN for which the INN is quinisocaine. It is also a surface anaesthetic. There are no medicines containing this registered in New Zealand and it is not included in the schedule. |
||||||
8.2.20 |
LignocaineThe scheduling of lignocaine should be as follows:
NB The New Zealand schedule would retain the current exemptions from prescription status for named health professionals. The NDPSC recognises that different legislative controls prevent harmonisation of these entries. |
||||||
8.2.21 |
PrilocaineThe scheduling of prilocaine should be as follows:
The exemption from prescription status for use by dental therapists would remain in the New Zealand schedule. |
||||||
8.2.22 |
Oral vaccinesThe pharmacy-only entry should be removed from the schedule on the grounds that there were safety concerns about the registration process for oral vaccines if they were moved to pharmacy-only medicine. The recommendation overlooks the fact that oral vaccines are only pharmacy-only if they are not specified elsewhere in the schedule. It is New Zealand practice to list vaccines by ingredient. Any vaccines intended to be prescription medicines will be scheduled as such. |
||||||
8.2.23 |
NicoumaloneAdopt as a prescription medicine. There are no medicines registered in New Zealand which contain nicoumalone. |
||||||
8.2.24 |
TerebeneDelete the restricted medicine entry. New Zealand has a pharmacy-only entry for internal use which is probably the entry intended in the recommendation. There are no products listed in New Zealand under terebene. There is no reference in Martindale. |
||||||
8.2.25 |
Monosulfiram and dichlofenthionDelete the pharmacy-only entries. There are no medicines registered in New Zealand containing either of these medicines. There is no reference in Martindale to the latter. There are other pesticides preferred to monosulfiram. |
||||||
8.2.25 |
Nystatin and hexamidineReassess the scheduling of nystatin and hexamidine in dermal products for tinea pedis. While there are no nystatin products registered specifically for this indication there are several pharmacy-only products for dermal infections. Hexamidine is general sale for all indications. It was moved to general last year as part of the harmonisation project. |
||||||
8.2.25 |
Mandelic acidRemove from the schedule. Mandelic acid is currently classified as pharmacy-only medicine. There are no medicines registered in New Zealand which contain mandelic acid. |
||||||
8.2.26 |
strychnine and brucine
Note that strychnine is an Appendix G medicine in Australia which means it is exempt from scheduling below a concentration other than the standard one, in this case, 1 mg/kg. A statement to this effect would need to be added to the New Zealand schedule entry. An entry for strychnos nux vomica appears redundant when there is already an entry covering all strychnos species. However, retention of the name nux vomica as a separate entry might help avoid confusion as this is the name by which the medicine has traditionally been known. Brucine would presumably be covered by the prescription medicine entries for strychnos or nux vomica. There are no medicines registered in New Zealand containing any of these substances. |
||||||
8.2.27 |
Savin oilReclassify to prescription medicine as Juniperus sabine Juniperus sabina is one of the herbals for which a delay had been requested for classification as a prescription medicine and for which Medsafe had agreed that no further action should be taken over until the outcome of the joint agency proposal was known. However, the PDR For Herbal Medicines states that the medicinal part of Juniperus sabina or savin tops are the essential oil of the leaves and branch tips; the dried leafy branch tips; the fresh non-woody branch tips with leaves; and the branches and leaves. Savin oil is already a prescription medicine which means that it is unavailable for use in complementary medicines. However, there may be complementary medicines derived from parts of the plant other than the essential oil. Changing the name to Juniperus sabina may increase the scope of the substance to be classified. |
||||||
8.2.28 |
PregnenoloneDelete 'except in preparations for topical use' from the prescription medicine entry on the grounds that this recommendation was obsolete. This wording was added to the New Zealand schedule at the request of the NDPSC. New Zealand has no medicines containing this substance. |
||||||
8.2.29 |
Potassium chlorateMake a new pharmacy-only entry for potassium chlorate except when in medicines containing 10% or less of potassium chlorate. New Zealand has only one product registered and this would remain general sale. |
||||||
8.2.30 |
EphedraReclassify to prescription medicine as follow: Ephedra spp: except in preparations containing 0.001% or less of ephedrine See also agenda item 8.1.3 above. |
||||||
8.2.31 |
AdenosineAdd 'for injection' to the prescription medicine entry. Medsafe had previously queried this recommendation on the grounds that any other route of administration would automatically become general sale. It appears that there is a complementary medicine in Australia which is in tablet form and which is not scheduled. There is no such product registered in New Zealand. |
||||||
8.2.32 |
Benzyl benzoateDelete from the schedule. This would result in products containing more than 2.5% moving from pharmacy-only to general sale. The highest strength currently registered is a 25% topical solution. |
||||||
8.2.33 |
BenorylateReclassify from pharmacy-only medicine to prescription medicine. New Zealand has no registered medicines containing benorylate |
||||||
8.2.34 |
BenzydamineReclassify as prescription medicine except for topical use. New Zealand has only topical (ie external products). However, benzydamine has been used orally and by injection. |
||||||
8.2.35 |
IbuprofenNew Zealand should adopt the revised wording of the SUSDP 15 (2) amendment for ibuprofen that: sets an upper daily dose for divided and undivided preparations for ibuprofen (1200mg) relaxes the concentration requirements for ibuprofen liquid preparations but retains a 4 gram total content of ibuprofen in these packs (no concentration specified). |
||||||
8.2.36 |
SilverModify the pharmacy-only entry so that the following are general sale medicines oral solutions containing 0.3% or less other medicines containing 1% or less Shift the wording of the current pharmacy-only exemption for silver sulfadiazine from the 'silver' to the 'silver sulfadiazine' entry*. Adopt the SUSDP warning statement 'overuse may stain skin or mouth' for silver solutions for oral use or in chewing gums. New Zealand does not appear to have any registered products which would be affected by the classification change. There are no products which would justify the inclusion of the above warning statement into the New Zealand Regulatory Guidelines. *For silver sulfadiazine, see later recommendation made in November 2001 to reclassify to prescription medicine for all strengths (agenda item 8.5.1). |
||||||
8.2.37 |
SeleniumChange the classification of products for external use containing more than 2.5% from pharmacy-only to prescription medicine. This is inconsistent in that it would make external products more restrictively classified than internal products. All internal products containing more than 150 mcg per recommended daily dose would remain pharmacy-only. Two shampoos registered in New Zealand would remain general sale. |
||||||
8.2.38 |
Pyrithione zincClassify as pharmacy-only except when in shampoos containing 2% or less. This is currently general sale in New Zealand and is covered under the entry for zinc for external use. There are a large number of shampoos marketed, most of which contain 1% or less. However, there is one shampoo containing 2.08% which would become a pharmacy-only medicine. |
||||||
8.2.39 |
GuaiphenesinReclassify to prescription medicine except for oral liquids containing 2% or less or solid dose forms containing 200 mg or less which should become general sale medicines. The change should not affect any of the general sale products currently on the market. |
||||||
8.2.40 |
Mannityl hexanitrate, erythryl tetranitrateReclassify from pharmacy-only to restricted medicine for consistency with isosorbide dinitrate and glyceryl trinitrate. New Zealand has no products containing either medicine. |
||||||
8.3 |
Recommendations made by the NDPSC to the MCC in May 2001 |
||||||
8.3.1 |
Folic acid and folinic acidReclassify to:
Calcium folinate (leucovorin) tablets come in strengths of 10 mg and 15 mg only. There are no tablets containing less than 10 mg. These recently moved from PM to RM at the recommendation of the NDPSC and would now move again to PO. There would be no change to the current classification of folic acid tablets (max 5mg) but injections would move to PM. An exemption from PM would be required for folic acid to allow use at general sale level in parenteral nutrition replacement preparations. Folinic acid does not appear to be used in this way. |
||||||
8.3.2 |
Polysulphated glycosamino glycansAdd to the list of prescription medicines. In the New Zealand schedules, these medicines would be listed according to their individual names. It is not know which medicines would be covered by this entry. |
||||||
8.3.3 |
HypromelloseSchedule as a prescription medicine when contained in injections. Hypromellose is not contained as an excipient in any injectable medicines which are not already prescription medicines by virtue of their active ingredients. Therefore a cut-off point or exemption statement to avoid catching medicines which should be less restrictively classified would unnecessary. One product would move from pharmacy-only to prescription. |
||||||
8.3.4 |
LevetiracetamAdd to the schedule as a prescription medicine. This is a new chemical entity for use in epileptic patients for the treatment of partial onset seizures. New Zealand has not received an application for consent to market a medicine containing levetiracetam. |
||||||
8.4 |
Recommendations made by the NDPSC to the MCC in August 2001 |
||||||
8.4.1 |
NizatidineReclassify from restricted medicine to pharmacy-only medicine when for the relief of symptoms of oesophageal reflux and when in packs containing not more than 14 days' supply. This would bring the OTC classification of nizatidine into line with that of ranitidine and famotidine. There are no longer any nizatidine products marketed in New Zealand. |
||||||
8.4.2 |
BexaroteneAdd to the schedule as a prescription medicine. Bexarotene is a new chemical entity not registered for consent to market in Australia or New Zealand but available in Australia through the Special Access Scheme when used for the treatment of T-cell lymphoma. |
||||||
8.4.3 |
BifonazoleAmend the pharmacy-only entry to allow scalp preparations containing 1% or less to become general sale medicines as for ketoconazole. There is one product in New Zealand which would be affected by this change. |
||||||
8.4.4 |
MinoxidilReclassify topical preparations containing 5% or less from restricted medicine to pharmacy-only medicine. There is a submission requesting the reclassification of 2% topical minoxidil to pharmacy-only on the current agenda. |
||||||
8.4.5 |
Darbepoetin alphaAdd to the schedule as a prescription medicine. |
||||||
8.5 |
Recommendations made by the NDPSC to the MCC in November 2001To follow |
||||||
8.5.1 |
Silver sulfadiazineShould be classified as a prescription medicine at all strengths. Silver sulfadiazine is permitted as a pharmacy-only medicine in New Zealand in packs containing 50 grams or less. There is only one OTC pack available, Silvazine Topical Cream. |
||||||
8.5.2 |
NitrofurazoneReclassify to prescription medicine. Nitrofurazone is currently classified as a pharmacy-only medicine. There are no longer medicines registered in New Zealand containing nitrofurazone. |
||||||
8.5.3 |
ClindamycinClindamycin for topical use should be reclassified from restricted medicine to prescription medicine. Increasing rates of resistance to clindamycin have been noted in New Zealand against a background of more widespread availability for the treatment of acne. |
||||||
Other Recommendations Made in November 2001 |
|||||||
8.5.4 |
Butyl aminobenzoateAmend the current prescription medicine classification to allow dermal preparations containing 2% or less to be general sale medicines in line with other local anaesthetics. New Zealand no longer has a product containing butyl aminobenzoate. Note that local anaesthetics which are general sale in New Zealand at 2% or less are usually pharmacy-only medicine rather than prescription medicine at strengths greater than 2%. |
||||||
8.5.5 |
Solanaceous plants and alkaloidsThe proposed amendments apply only to pharmacy-only entries. When the NDPSC recommended that New Zealand should consider adopting similar scheduling outcomes it overlooked the fact that the more restrictive classifications in Australia are prescription medicines whereas the higher oral doses are restricted medicines in New Zealand with injectable and ophthalmic products only being classified as prescription medicines. It is unclear whether the recommendation implies that the New Zealand restricted medicine category should remain. The following pharmacy-only entries have been recommended Atropa belladonna
Atropine
Datura spp for oral use except when separately specified in these Schedules:
Datura stramonium for oral use when:
except for smoking or burning. Datura tatula for oral use when:
except for smoking or burning. Duboisia leichhardtii for oral use:
Duboisia myoporides for oral use:
Hyoscine (excluding hyoscine butyl bromide)*
Hyoscyamine
Hyoscyamus niger for oral use:
*Note: Any change to the hyoscine entry in the New Zealand schedule would have an effect on the classification of hyoscine butylbromide which is not scheduled separately. The SUSDP also has the following separate pharmacy-only entry: hyoscine butylbromide as the only therapeutically active substance in divided preparations for oral use containing 10 mg or less of hyoscine butylbromide per dosage unit in a pack containing 20 or less dosage units. New Zealand does not have separate entries for hyoscine butylbromide. There is no prescription medicine entry for hysoscine butylbromide in the SUSDP to cover strengths or pack sizes greater than those permitted for pharmacy-only. Buscopan 10mg tablets are restricted medicine in New Zealand. They would become pharmacy-only if the above entry for hyoscine were amended in the New Zealand schedule. The Committee has considered company submissions for reclassification of Buscopan tablets to pharmacy-only medicine on two previous occasions but has so far maintained its position that these should remain classified as restricted medicine. |
||||||
8.5.6 |
Aristolochic acidMake a new prescription medicine entry in for aristolochic acid at all strengths in addition to the entry for aristolochia spp in order to harmonise with changes to the wording in Appendix C of the SUSDP and to cover aristolochic acids obtained from other species. |
||||||
8.5.7 |
Podophyllum and podophyllotoxinSchedule as follows: Prescription medicine Podophyllum emodi
Podophyllum pelatum
Podophyllotoxin
Restricted Medicine
Pharmacy-only medicine
|
||||||
8.5.8 |
Beclomethasone and fluticasoneAmend the schedule entries to allow beclomethasone and fluticasone to be sold as restricted medicines for both seasonal and perennial allergic rhinitis. The term 'allergic rhinitis' to be used to cover both conditions. New Zealand does not schedule these according to indications. A change would be required to the labelling requirements for OTC nasal corticosteroids in the New Zealand Regulatory Guidelines. The NDPSC has also requested a company submission in support for a similar change for budesonide. New Zealand also markets OTC mometasone and triamcinalone with the same indications for OTC sale as beclomethasone, budesonide and fluticasone |
||||||
9. |
For the Next Meeting |
||||||
10. |
General Business |