The FDA has approved a new formulation of carbidopa/levodopa (Rytary – Impax) in extended-release capsules for treatment of Parkinson's disease (PD).
CARBIDOPA/LEVODOPA — The combination of levodopa and carbidopa is still the most effective pharmacologic treatment for symptomatic relief of PD.1 It has been available for many years as immediate- and sustained-release tablets (Sinemet, Sinemet CR, and generics), orally disintegrating tablets, and in combination with the COMT inhibitor entacapone (Stalevo, and generics). Sustained-release tablets have a slower and less predictable onset of action than immediate-release tablets. Many patients must take a half or a whole immediate-release tablet concomitantly with sustained-release tablets, particularly with the first dose of the day. Some small studies in patients with PD fluctuations have found no significant difference in "off" time between sustained-release and immediate-release
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The FDA has approved Glyxambi (Boehringer Ingelheim/Lilly), a fixed-dose combination of empagliflozin (Jardiance) and linagliptin (Tradjenta), for oral treatment of type 2 diabetes in adults. It is the first combination of a sodium-glucose co-transporter 2 (SGLT2) inhibitor and a dipeptidyl peptidase-4 (DPP-4) inhibitor to be approved in the US.
STANDARD TREATMENT — Used alone, oral antihyperglycemic drugs generally lower glycated hemoglobin (HbA1c) by 0.5%-1.5%. In the absence of contraindications, metformin is the preferred first-line agent.1 If metformin does not achieve the desired goal, a second drug is usually added. If maximum doses of 2 drugs prove insufficient, a third can be added. Most patients with type 2 diabetes eventually require multi-drug therapy or insulin to achieve glycemic control. Some diabetes experts favor early use of insulin if HbA1c remains poorly controlled on maximal-dose single-drug therapy.