Cilazapril: No new patients from 1 May 2021

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Cilazapril is used in New Zealand much more than any other country. To reduce the risk of supply issues, we are asking prescribers to move away from the use of cilazapril.

On this page

10 May 2021 update

We've updated this page in response to questions from pharmacists. If you still have questions about this change, email enquiry@pharmac.govt.nz

No new patients

We are restricting funded access to cilazapril to existing patients only.

  • 1 April 2021 | Endorsement added to cilazapril in Section H – Hospital Medicines
  • 1 May 2021 | Endorsement added to cilazapril in the Community Schedule. No new patients can start on cilazapril.

Note: This applies to cilazapril only. Cilazapril with hydrochlorothiazide has been discontinued by the supplier.  

Read more about the cilazapril with hydrochlorothiazide discontinuation

Why is cilazapril being restricted?

Cilazapril is used in New Zealand much more than any other country. There is only one place in the world that makes the active ingredient for cilazapril.

Cilazapril is not used much in other countries. If there were a manufacturing or supply issue that affected New Zealand’s supply, it would be impossible for us to find enough cilazapril for everyone who takes it. 

To reduce the risk, we want to support people to move away from using cilazapril. Our first step is to stop new people starting on cilazapril. Further down the track, people currently taking cilazapril may have to move to a different medicine.   

Prescribers: What you need to do

When prescribing an ACE inhibitor or angiotensin II antagonist (ARB):

  • do not start any new patients on cilazapril
  • consider transferring your existing patients to a different medicine.

Check the Schedule for all funded agents affecting the renin-angiotensin system(external link)

Help finding an alternative treatment

Switching blood pressure medications – it’s time to break the cilazapril habit - He Ako Hiringa(external link) 

Read BPAC’s advice on prescribing ACE inhibitors(external link) 

Read about treating hypertension and heart failure in the NZ Formulary(external link)

Read advice from Dr Richard Medlicott, former Medical Director of the Royal New Zealand College of General Practitioners

Patients: What you need to do

Already taking cilazapril?

If you were taking cilazapril on 30 April 2021, you can continue to use cilazapril. You may also like to talk to your prescriber about moving to a different medicine.

Cilazapril remains a safe and effective medicine. We are making this change to reduce the risk of supply issues affecting people. 

Got a new prescription for cilazapril?

If you were not taking cilazapril on 30 April 2021, you will need to be prescribed a different treatment. 

We apologise for any inconvenience this change causes. 

Treatment options available 

Read more about angiotensin II antagonists (ARBs) - Health Navigator(external link)

Read more about ACE inhibitors - Health Navigator(external link)

Pharmacists: What you need to know

We applied a Schedule endorsement “for existing cilazapril patients only” from:

  • 1 April 2021 – Section H
  • 1 May 2021 – Section B.

Pharmacists can annotate the prescription as endorsed where there exists a record that the person had a recent prescription for cilazapril. 

Cilazapril will not be funded for patients previously taking cilazapril with hydrochlorthiazide.

The endorsement affects all 3 presentations of cilazapril (Zapril):

  • Tab 0.5 mg - pharmacode: 2399059
  • Tab 2.5 mg - pharmacode: 2379082
  • Tab 5 mg - pharmacode: 2379090

We know that changing the Schedule in this way may create additional work for you. This is currently the main lever we have to change prescribing behaviour. We appreciate you and the work you do. 

The future of cilazapril

The current supply of cilazapril is secure. 

We know many people taking cilazapril have complex health conditions. We want to minimise any disruption. We are moving slowly as we encourage the shift away from cilazapril.

We will share the time line for transition as it becomes available.