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The Medical Letter on Drugs and Therapeutics • December 9, 2013 (Issue 1431)
An outbreak (8 cases to date) of meningococcal disease at Princeton University caused by Neisseria meningitidis serogroup B has led the FDA and CDC to permit importation and investigational use (at Princeton University only) of a meningococcus B vaccine (4CMenB; Bexsero – Novartis) that has not been approved in the US. Bexsero has been approved for use in the European...
The Medical Letter on Drugs and Therapeutics • November 25, 2013 (Issue 1430)
The FDA recently issued a Drug Safety Communication saying that it had asked the manufacturer of ponatinib (Iclusig – Ariad) to suspend marketing and sales of the drug because of the risk of life-threatening blood clots and severe narrowing of blood vessels.1 Ponatinib is a tyrosine kinase inhibitor that was granted accelerated approval by the FDA in December 2012...
The Medical Letter on Drugs and Therapeutics • November 25, 2013 (Issue 1430)
The FDA recently announced changes in the labeling of ezogabine (Potiga – GSK/Valeant) to warn about the risks of retinal abnormalities, possible vision loss, and bluish skin discoloration, all of which could be permanent.1

Ezogabine was approved in 2011 for adjunctive treatment of partial-onset seizures in adults.2 The FDA first...
The Medical Letter on Drugs and Therapeutics • November 11, 2013 (Issue 1429)
Electronic cigarettes, also called e-cigarettes, are advertised as a safer, more convenient, and socially acceptable alternative to smoking tobacco cigarettes. Widely available in retail stores and on the Internet, their use has been increasing over recent years, primarily among smokers, but also among non-smokers.
The Medical Letter on Drugs and Therapeutics • November 11, 2013 (Issue 1429)
The FDA is requiring new warnings about peripheral neuropathy in the labeling of all oral and injectable fluoroquinolones. The potential for this class of antibiotics to cause peripheral neuropathy was first identified more than 10 years ago and a warning was added to their labels in 2004. The new warnings are based on a recent review of the FDA’s Adverse Event Reporting System (AERS) database....
The Medical Letter on Drugs and Therapeutics • November 11, 2013 (Issue 1429)
Rates of meningococcal disease are highest in infancy, but until recently no meningococcal vaccine was approved for use in this age group. MenHibrix (GSK), a new conjugate vaccine that protects against Neisseria meningitidis serogroups C and Y and Haemophilus influenzae type b (Hib), has been approved by the FDA for use in infants ≥6 weeks old and Menveo, a...
The Medical Letter on Drugs and Therapeutics • October 28, 2013 (Issue 1428)
The CDC recently announced that it will now supply the investigational drug miltefosine (Impavido – Paladin, Canada) for treatment of infections caused by free-living amebae.1 The drug was previously available in the US only from the manufacturer through an FDA Investigational New Drug (IND) application.

Meningoencephalitis caused by the free-living amebae...
The Medical Letter on Drugs and Therapeutics • October 14, 2013 (Issue 1427)
A new sublingual tablet formulation of the partial opioid agonist buprenorphine combined with the opioid antagonist naloxone (Zubsolv – Orexo) has been approved by the FDA for maintenance treatment of opioid dependence. Zubsolv tablets have relatively greater bioavailability than previously approved sublingual film (Suboxone) and sublingual tablet formulations of...
The Medical Letter on Drugs and Therapeutics • October 14, 2013 (Issue 1427)
Deep brain stimulation is FDA-approved and has been used for years to treat patients with advanced Parkinson's disease (PD) who have severe levodopa-induced motor complications. New evidence from a controlled trial suggests that it may also be effective for patients with PD and early motor complications.
The Medical Letter on Drugs and Therapeutics • September 30, 2013 (Issue 1426)
Full-page newspaper advertisements and a series of television commercials have urged patients with atrial fibrillation to "rethink warfarin" in favor of Eliquis (apixaban – Bristol-Myers Squibb). Apixaban is the latest of 3 new oral anticoagulants now competing with warfarin (Coumadin, and others) for the oral anticoagulant market.
The Medical Letter on Drugs and Therapeutics • September 30, 2013 (Issue 1426)
The FDA has approved dolutegravir (doll-you-TEG-rah-veer; Tivicay – Viiv Healthcare), an integrase strand transfer inhibitor (INSTI), for treatment of HIV-1 infection in adults and in children ≥12 years old who weigh at least 40 kg. It is the third INSTI to be approved by the FDA; raltegravir and elvitegravir were approved earlier.
The Medical Letter on Drugs and Therapeutics • September 16, 2013 (Issue 1425)
The transdermal patch formulation of the anticholinergic drug oxybutynin (Oxytrol – Watson) is now available over the counter (OTC) as Oxytrol for Women (MSD) for use in women with overactive bladder (OAB). It is the first treatment for OAB to become available OTC. Oxybutynin remains available only by prescription for men.

OAB, characterized by symptoms of urgency,...
The Medical Letter on Drugs and Therapeutics • August 19, 2013 (Issue 1423)
The FDA has approved a new oral solution of the calcium channel blocker nimodipine (Nymalize – Arbor) to reduce the severity of neurological deficits associated with vasospasm after subarachnoid hemorrhage from a ruptured intracranial aneurysm. An older formulation of nimodipine has been available for such use for many years.1

Since 1988, nimodipine has...
The Medical Letter on Drugs and Therapeutics • June 24, 2013 (Issue 1419)
The progestin levonorgestrel is available over the counter for emergency contraception as two 0.75-mg tablets taken 12 hours apart (generic formulations of Plan B) and as a single 1.5-mg tablet taken once (Plan B One-Step, and generics). A third emergency contraceptive, ulipristal (Ella – Watson), is available with a prescription.1 It appears that...
The Medical Letter on Drugs and Therapeutics • June 10, 2013 (Issue 1418)
The FDA is advising health care professionals not to prescribe valproate sodium (Depacon), valproic acid (Depakene, Stavzor, and generics) or divalproex sodium (Depakote, Depakote ER, and generics) for migraine prevention in pregnant women because a recently published study showed that IQ scores are decreased in children of mothers who took these drugs during pregnancy...
The Medical Letter on Drugs and Therapeutics • April 15, 2013 (Issue 1414)
Two FDA advisory committees recently concluded that use of a nasal spray formulation of the peptide hormone salmon calcitonin for treatment of postmenopausal osteoporosis is associated with an increased risk of cancer. Salmon calcitonin is available as 2 nasal sprays (Miacalcin, Fortical) and an injectable formulation (Miacalcin Injection) for use in osteoporosis....
The Medical Letter on Drugs and Therapeutics • April 1, 2013 (Issue 1413)
The FDA has announced that it is requiring changes in the labeling of the macrolide antibiotic azithromycin (Zithromax, Zmax) to warn about the risk of QT prolongation and cardiac arrhythmias.1 The new warnings are based on a retrospective study in The New England Journal of Medicine (reviewed previously in The Medical Letter2...
The Medical Letter on Drugs and Therapeutics • February 18, 2013 (Issue 1410)
A new epinephrine auto-injector is available in the US (Auvi-Q – Sanofi; Allerject in Canada) for emergency treatment of anaphylaxis. The new device is about the length and width of a credit card and as thick as a smartphone. It has a retractable needle system and a red safety guard located at the same end as the needle. Activation of the device by removing the outer case...
The Medical Letter on Drugs and Therapeutics • February 4, 2013 (Issue 1409)
Two new trivalent influenza vaccines, Flucelvax (Novartis) and Flublok (Protein Sciences), will soon be available for prevention of seasonal influenza in adults ≥18 years old (Flucelvax) and 18-49 years old (Flublok). Unlike other available influenza vaccines, neither vaccine is produced in eggs, removing any concern regarding use in egg-allergic patients....
The Medical Letter on Drugs and Therapeutics • January 21, 2013 (Issue 1408)
The oral retinoid isotretinoin (Accutane, and others) is the most effective drug available for treatment of acne.1 The FDA has recently approved a new oral isotretinoin product (Absorica – Cipher/Ranbaxy) for treatment of severe, recalcitrant nodular acne.

Isotretinoin can completely clear severe nodulocystic lesions, in some cases leading to...