The FDA has approved lofexidine (Lucemyra – US WorldMeds/Salix), a centrally acting alpha₂ receptor agonist, to manage withdrawal symptoms in adults abruptly stopping opioid use. Available in the UK since 1992, lofexidine is the first nonopioid to be approved in the US for management of opioid withdrawal symptoms. Clonidine (Catapres, and generics), another central alpha₂ receptor agonist, has been used off-label for this indication for many years.

STANDARD TREATMENT — The partial opioid agonist buprenorphine is the drug of choice for management of opioid withdrawal in most patients.1 It is comparable in efficacy to the full opioid agonist methadone, but it is safer and does not need to be obtained through a licensed outpatient treatment program. Clonidine is less effective than methadone or buprenorphine; it is most useful as an adjunct to an opioid agonist or as an alternative in settings...  Continue reading

The FDA has approved two new ophthalmic drugs for reduction of intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension: latanoprostene bunod (Vyzulta – Bausch and Lomb), a modified prostaglandin analog, and netarsudil (Rhopressa – Aerie), the first Rho kinase inhibitor to be approved in the US.

STANDARD TREATMENT — A prostaglandin analog such as latanoprost (Xalatan, and generics) is generally the drug of choice for initial treatment of glaucoma. Dosed once daily in the evening, prostaglandin analogs typically lower IOP by 25-30% throughout the night and following day. They are generally well tolerated and have few, if any, systemic effects.

Topical beta blockers such as timolol (Timoptic, and others) are also commonly used; they lower IOP by ... Continue reading