Emergency contraception can be used to prevent pregnancy when contraception has failed or was not used, or after a sexual assault. Methods of emergency contraception available in Australia include 2 kinds of oral pills (levonorgestrel and ulipristal acetate) and the copper intrauterine device. Oral emergency contraception can be obtained from pharmacies without a prescription, while the copper intrauterine device must be inserted by a trained healthcare provider. For greatest effectiveness after unprotected sexual intercourse, oral levonorgestrel should be taken within 72 hours (3 days), ulipristal acetate should be taken within 120 hours (5 days) or the copper intrauterine device should be inserted within 120 hours.
Cardiovascular-kidney-metabolic (CKM) syndrome recognises the connection between metabolic conditions (particularly obesity, diabetes and metabolic dysfunction-associated fatty liver disease), chronic kidney disease and cardiovascular disease. There is a high and growing prevalence of CKM syndrome. While genetic and epigenetic factors predispose to CKM syndrome, the emergence of disease is heavily influenced by social determinants of health and individual behaviours. The pathophysiology of CKM syndrome is driven by insulin resistance, inflammation, oxidative stress and vascular dysfunction. Urinary albumin:creatinine ratio is a relatively cheap and accessible biomarker of CKM syndrome, which can be used to identify and monitor disease trajectory. Primary and secondary prevention is relevant across the life course. Healthy behaviours, including diet, physical activity, sleep and stress management are important. There are established and emerging drugs that are effective across a range of metabolic conditions and that confer reno- and cardio-protective effects. Remission may be achievable.
Irritable bowel syndrome (IBS) is a disorder of gut-brain interaction characterised by recurrent abdominal pain or discomfort that is often related to defaecation or associated with a change in stool frequency or form. IBS is common in Australia and affects women more than men. The exact pathophysiology remains unclear, though it can be multifactorial and relate to gastrointestinal dysmotility, post-infection and microbial changes, and a patient's psychosocial background. A positive clinical diagnosis can be made when the Rome V criteria are met, alarm features are absent and simple screening tests (full blood count, C-reactive protein, coeliac serology) are negative. If alarm features are present, further examination, laboratory testing or imaging may be helpful in assessing for organic pathology. Management involves lifestyle and dietary modifications, and psychological and pharmacological therapies. Pharmacological therapy should be individualised to the patient's IBS subtype and symptoms. Examples of drug classes that are used include antispasmodics, osmotic laxatives, antidiarrhoeal drugs and neuromodulators (tricyclic antidepressants). There is insufficient evidence to support the use of therapies such as probiotics, faecal microbiota transplantation, and mesalamine.
Sodium valproate (valproate) is an approved treatment for epilepsy and bipolar disorder in Australia. It is associated with a range of adverse effects that require monitoring and may limit its use. Due to its teratogenicity, valproate should not be prescribed to women of childbearing potential. Lamotrigine or levetiracetam are preferred alternatives in epilepsy. If no alternative is suitable and valproate is prescribed, contraception should be co-prescribed. Concerns have been raised about the potential risk of neurodevelopmental disorders in children born to men taking valproate; although these findings have not been confirmed in robust studies, male patients should be informed of the potential risk.
One in seven Australians takes an antidepressant, with around half taking them long-term (over 12 months). Unnecessarily prolonged antidepressant use should be avoided because of the risk of adverse effects. A thorough mental health and medication history should inform whether it is appropriate to attempt to stop an antidepressant. The time to stop may be when the recommended duration of therapy is complete and there is no clinical indication for continued use, or where there are adverse effects that outweigh the benefits. Stopping antidepressants abruptly may precipitate withdrawal symptoms. Withdrawal symptoms may be more likely with longer duration of therapy and with certain antidepressants, such as duloxetine, venlafaxine and paroxetine. Slowly decreasing the antidepressant dose (tapering) can help to minimise withdrawal symptoms. The optimal antidepressant tapering approach is not yet known. Tapering usually involves decreasing the antidepressant dose in smaller decrements as the dose is lowered. In patients at low risk of withdrawal symptoms, guidelines recommend 25 to 50% dose reductions over 2 to 6 weeks (e.g. sertraline 100 mg tapered at 2-weekly intervals to 50 mg, 25 mg, then stop). In patients at higher risk of withdrawal symptoms, and those who have experienced difficulty stopping, smaller dose reductions over many weeks or months, through to very low drug doses (e.g. sertraline 1 mg), may be necessary; this may require compounded or liquid 'mini doses'.
Accurately measuring blood pressure is imperative for diagnosis and control of hypertension. There is a range of devices and methods for measuring blood pressure that each have advantages and limitations. To ensure accuracy of blood pressure measurement and hypertension diagnosis, clinicians and patients should use an accurate and validated blood pressure measurement device, an appropriately sized cuff, and take several measurements rather than only one measurement, using a standardised measurement protocol. Out-of-clinic measurement, using an ambulatory or home blood pressure monitoring device, depending on patient preference, should be used to confirm diagnosis and guide treatment of hypertension. There are emerging new technologies for blood pressure measurement (e.g. wearable technologies) that are yet to be validated and have the potential to improve blood pressure monitoring and patient self-management.
Vitamin B12 testing is recommended for individuals with clinical signs and symptoms suggestive of B12 deficiency, and when there is reasonable clinical suspicion of deficiency due to risk factors (e.g. inadequate dietary intake, malabsorptive conditions). Where vitamin B12 testing is indicated, total serum B12 is typically the first-line test. Active B12 may be requested if total B12 results are indeterminate, or during pregnancy. If total or active B12 tests are inconclusive, methylmalonic acid or homocysteine testing may be considered; however, their concentrations may be elevated in other conditions. In individuals with confirmed B12 deficiency, B12 supplementation is required, with the choice of formulation, duration and dosage guided by the underlying cause and severity of the deficiency and patient preference.
Metabolic dysfunction-associated fatty liver disease (MAFLD) affects 1 in 3 Australian adults and is an under-recognised but growing cause of liver cirrhosis, hepatocellular carcinoma and liver transplantation. There is a major role for primary care in MAFLD prevention, diagnosis and management. Adults with obesity, type 2 diabetes or other metabolic risk factors should be assessed for MAFLD. Liver ultrasound is the recommended first-line test for diagnosing hepatic steatosis (fat accumulation in hepatocytes). Management of MAFLD includes noninvasive testing for liver fibrosis, addressing health risk behaviours and comorbidities, and hepatocellular carcinoma surveillance in those with liver cirrhosis.
Cytomegalovirus (CMV) is the most common congenital infection in Australia and a leading cause of preventable childhood disability. Current Australian guidelines recommend targeted antenatal screening of women at higher risk for CMV infection. Serology testing should also be considered in women with clinical symptoms suggestive of CMV. Women with suspected CMV infection in pregnancy should be promptly referred to a maternal-fetal medicine or infectious diseases specialist. High-dose valaciclovir can reduce in utero transmission to the fetus following first-trimester maternal primary infection; however, long-term safety data are limited. Valaciclovir should only be prescribed by clinicians with specific expertise in CMV, such as maternal-fetal medicine or infectious diseases specialists. Universal hygiene counselling, targeted screening, careful timing of conception after infection, and structured psychological support are essential components of care.
Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that is characterised by inattention, hyperactivity or impulsivity. It affects around 3 to 5% of adults. The main pharmacotherapies for adults with ADHD include psychostimulants, such as methylphenidate and amphetamines (dexamfetamine and lisdexamfetamine), and non-psychostimulants such as atomoxetine. In Australia, the eligibility for subsidy under the Pharmaceutical Benefits Scheme varies depending on whether the patient was diagnosed with ADHD during childhood or adulthood. Individuals prescribed ADHD drugs should be monitored for both physical (e.g. cardiac symptoms, appetite changes, seizures) and psychiatric (e.g. mood disturbances, anxiety, psychosis) adverse effects. While pharmacological treatment is effective for adults with ADHD, it should be integrated into a broader, multidisciplinary approach that also includes nonpharmacological strategies such as psychological therapies and allied health support.
Viscosupplementation with intra-articular hyaluronic acid derivatives and cross-linked polymers of hyaluronic acid is increasingly used to treat symptomatic osteoarthritis in the knee, hip and other joints. Most guidelines conditionally recommend against its use to treat knee osteoarthritis, and strongly or conditionally recommend against its use for other joints, indicating a large evidence-topractice gap. Conclusive evidence from randomised placebo-controlled trials indicates that intra-articular hyaluronic acid provides no important benefits for people with knee (and other joints) osteoarthritis, and may have potentially serious harms including septic arthritis and severe inflammatory joint and cutaneous reactions. Use of computed tomography scans to guide hyaluronic acid injection exposes the patient to unnecessary radiation and has an unwarranted financial and environmental cost. When the topic arises in clinical practice, prescribers should use a shared decision-making approach that includes an explanation as to why hyaluronic acid injection is not recommended care for osteoarthritis and offer alternatives, taking into consideration the patient's values and preferences.
Acute coronary syndromes (ACS) remain a significant cause of disability and death in Australia. Following an initial acute coronary event, there is a significant risk of recurrence, particularly in the first 90 days. In April 2025, the National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand launched a new Australian clinical guideline for diagnosing and managing ACS. The guideline includes recommendations for the secondary prevention of ACS. Pharmacotherapies for secondary prevention of ACS include antiplatelet and anticoagulant drugs, lipid-modifying therapy, beta blockers and renin-angiotensin antagonist therapies, plus - in select groups - colchicine and other therapies. Vaccination against influenza and other respiratory pathogens is recommended. Nonpharmacological interventions include cardiac rehabilitation, healthy behaviour changes and screening for mental health conditions. The importance of providing strategies to support adherence to long-term therapies is also emphasised.
Royal Commissions into the aged-care and disability sectors revealed significant concerns about the inappropriate use of psychotropic medicines as chemical restraint in people with cognitive disability or impairment. In response, the Australian Commission on Safety and Quality in Health Care developed the Psychotropic Medicines in Cognitive Disability or Impairment Clinical Care Standard (the Standard), aiming to guide psychotropic use and ensure best practice in supporting people with cognitive disability or impairment. This article provides an overview of the Standard and its application in the aged-care and disability sectors. The Standard promotes person-centred care and prioritises thorough assessment, non-medication strategies, and the development of individual behaviour support plans before considering psychotropic medicines. It encourages healthcare services to have clear policies around psychotropic use, including the need for documentation of non-medication strategies trialled before such use, and for monitoring the effectiveness of any psychotropic medicine prescribed. Informed consent is a regulatory requirement before using psychotropic medicines as a form of restrictive practice. Clear treatment goals, clinical handover during transitions of care, and regular psychotropic review and deprescribing are emphasised in the Standard to minimise harm, particularly in cases of long-term use and psychotropic polypharmacy.
Immunosuppressed patients are vulnerable to infections which can cause significant mortality and morbidity. A dedicated evaluation, performed prior to immunosuppression where possible, can improve infection-related outcomes for these complex patients. Strategies to reduce infection risk include individualised risk assessment, targeted screening investigations, antimicrobial prophylaxis, vaccination and education to reduce future exposures to infectious pathogens.
