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The Medical Letter on Drugs and Therapeutics • February 2, 2015 (Issue 1461)
The FDA has approved an IV formulation of the antifungal drug posaconazole (Noxafil - Merck) for prophylaxis of Aspergillus and Candida infections in adults at high risk for these infections, such as those with prolonged neutropenia. Posaconazole is also available as delayed-release tablets and an oral suspension.

With activity against Aspergillus...
The Medical Letter on Drugs and Therapeutics • January 19, 2015 (Issue 1460)
Some readers of our article on Antiviral Drugs for Seasonal Influenza1 have expressed concerns regarding our recommendation for use of the oral neuraminidase inhibitor oseltamivir (Tamiflu) to treat high-risk patients with confirmed or suspected influenza illness, citing the British Medical Journal and The Cochrane Collaboration, which have...
The Medical Letter on Drugs and Therapeutics • January 5, 2015 (Issue 1459)
The CDC has announced that the most common influenza viruses circulating now are influenza A H3N2, which tend to cause more severe disease, and that about half of these viruses are antigenically different from the H3N2 strain in this year’s flu vaccine.1 Vaccination may still have a protective effect, even against drifted variants, and patients who have not received this year...
The Medical Letter on Drugs and Therapeutics • December 8, 2014 (Issue 1457)
Antiviral drugs can be used for treatment of influenza and as an adjunct to influenza vaccination for prophylaxis. Frequently updated information on influenza activity and antiviral resistance is available from the CDC at www.cdc.gov/flu.
The Medical Letter on Drugs and Therapeutics • December 8, 2014 (Issue 1457)
The FDA has approved a new extended-release capsule formulation of topiramate (Qudexy XR – Upsher Smith), which can be opened and sprinkled on food for patients who have difficulty swallowing tablets or capsules, for treatment of epilepsy. Qudexy XR was marketed as a branded drug in March 2014 and as a generic drug four months later. An earlier extended-release formulation (...
The Medical Letter on Drugs and Therapeutics • December 8, 2014 (Issue 1457)
Combining a statin with another drug that lowers low-density lipoprotein cholesterol (LDL-C), such as colesevelam (Welchol), niacin (Niaspan, and others), or ezetimibe (Zetia), can reduce LDL-C levels more than a statin alone, but studies convincingly demonstrating that such combinations improve clinical outcomes have been lacking. The results of a long-term randomized...
The Medical Letter on Drugs and Therapeutics • October 13, 2014 (Issue 1453)
The FDA has approved Cologuard (Exact Sciences), a stool DNA test, to screen average-risk adults ≥50 years old for colorectal cancer.
The Medical Letter on Drugs and Therapeutics • October 13, 2014 (Issue 1453)
The US Advisory Committee on Immunization Practices (ACIP) now recommends routine immunization with 13-valent pneumococcal conjugate vaccine (PCV13; Prevnar 13), in addition to the 23-valent pneumococcal polysaccharide vaccine (PPSV23; Pneumovax 23), for all adults ≥65 years old.1

An unpublished, randomized, double-blind trial (...
The Medical Letter on Drugs and Therapeutics • September 1, 2014 (Issue 1450)
Wild poliovirus has circulated during the previous 12 months in Cameroon, Equatorial Guinea, Ethiopia, Iraq, Israel (also the West Bank and Gaza), Somalia, and Syria, as well as in those countries where polio is still endemic (Afghanistan, Nigeria, and Pakistan). The World Health Organization (WHO) has declared a public health emergency related to the possible spread of polio from affected...
The Medical Letter on Drugs and Therapeutics • July 21, 2014 (Issue 1447)
The FDA has approved the proton pump inhibitor (PPI) esomeprazole strontium for use in adults for the same indications as esomeprazole magnesium (Nexium): treatment of gastroesophageal reflux disease (GERD), prevention of NSAID-induced gastric ulcers, eradication of Helicobacter pylori, and treatment of pathological hypersecretory conditions. It was first marketed in December...
The Medical Letter on Drugs and Therapeutics • July 21, 2014 (Issue 1447)
The FDA has authorized two manufacturers (Teva, Mylan) to market generic formulations of celecoxib (Celebrex – Pfizer), the only COX-2 selective inhibitor remaining on the US market. Celecoxib is less likely than nonselective NSAIDs to cause gastric ulcers or other GI toxicity,1 and unlike traditional NSAIDs, it does not have an antiplatelet effect...
The Medical Letter on Drugs and Therapeutics • July 21, 2014 (Issue 1447)
The same pharmaceutical company (Iroko) that recently marketed low-dose diclofenac (Zorvolex) for treatment of mild to moderate acute pain1 has now received approval from the FDA to market a low-dose oral formulation of indomethacin (Tivorbex) for the same indication. Tivorbex is available in 20- and 40-mg capsules; conventional...
The Medical Letter on Drugs and Therapeutics • June 9, 2014 (Issue 1444)
A recent Medical Letter article reported renewed interest in the intranasal administration (off-label) of the opioid antagonist naloxone because of an increase in deaths from opioid overdose in the US.1 Now the FDA has approved a more practical alternative for emergency treatment of life-threatening opioid overdose in adults and children: a single-dose...
The Medical Letter on Drugs and Therapeutics • June 9, 2014 (Issue 1444)
The FDA has required the manufacturer of eszopiclone (Lunesta – Sunovion), a benzodiazepine receptor agonist approved for the treatment of insomnia, to lower the current recommended starting dose to 1 mg for both men and women because a new study found that an evening dose of 3 mg can impair driving skills, memory, and coordination for more than 11 hours....
Treatment Guidelines from The Medical Letter • June, 2014 (Issue 142)
Vaccines recommended for adults residing in the US are reviewed here. Vaccines for travel have been reviewed separately.

Eight vaccines are currently recommended by the US Advisory Committee on Immunization Practices (ACIP) for routine use in adults at various ages...
The Medical Letter on Drugs and Therapeutics • May 26, 2014 (Issue 1443)
The FDA has approved the use of an equine heptavalent botulism antitoxin (BAT, Cangene Corporation). The new antitoxin includes antibodies against all 7 botulinum neurotoxin types (A-G). A human-derived antitoxin (BabyBIG) has been available for years for infant botulism. The heptavalent product is now the preferred antitoxin for adult botulism. It is a solution of immunoglobulin fragments...
The Medical Letter on Drugs and Therapeutics • April 28, 2014 (Issue 1441)
One of our readers has suggested that more attention should have been paid to a study comparing the antiplatelet effects of immediate-release and enteric-coated aspirin that appeared in Circulation last year.1 The safety benefits of enteric-coated aspirin are unclear. It may protect against dyspepsia, but not against major gastrointestinal bleeding...
The Medical Letter on Drugs and Therapeutics • March 31, 2014 (Issue 1439)
The FDA has approved a new injectable formulation of methotrexate (Otrexup – Antares) for use in rheumatoid arthritis and polyarticular juvenile idiopathic arthritis, and for severe psoriasis in adults. On its web site (www.otrexup.com), the manufacturer states: "Otrexup is the first subcutaneous (SC) methotrexate (MTX...
The Medical Letter on Drugs and Therapeutics • March 3, 2014 (Issue 1437)
Prompted by the recent publication of 2 retrospective studies, the FDA has announced that it is investigating the risk of stroke, heart attack, and death in men taking FDA-approved testosterone products.1

The first study examined the records of 8709 men with low testosterone levels (<300 ng/dL) who underwent coronary angiography between 2005...
The Medical Letter on Drugs and Therapeutics • February 3, 2014 (Issue 1435)
The FDA has removed prescribing and dispensing restrictions placed on rosiglitazone (Avandia, and others) in 2010 because of concerns about its cardiovascular safety.1 The removal of restrictions was based on the results of an independent reevaluation of the RECORD trial, which found no significant difference between rosiglitazone and metformin/sulfonylurea in the...