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The Medical Letter on Drugs and Therapeutics • May 3, 2010 (Issue 1337)
The FDA has approved velaglucerase alfa (Vpriv – Shire), a new formulation of glucocerebrosidase prepared from human fibroblasts, for treatment of the nonneurologic form of Gaucher’s disease (Type 1). Patients with Gaucher’s disease have a congenital deficiency of glucocerebrosidase that leads to accumulation of glucosylceramide, the end-product of sphingolipid catabolism, in the...
The Medical Letter on Drugs and Therapeutics • March 22, 2010 (Issue 1334)
A little more than a year ago, The Medical Letter reported the results of an FDA meta-analysis which found that use of a long-acting beta-2 agonist (LABA) such as salmeterol (Severent) or formoterol (Foradil) in patients with asthma was associated with an increased risk of a composite endpoint of asthma-related death, intubation or hospitalization; the highest risk was in...
The Medical Letter on Drugs and Therapeutics • March 8, 2010 (Issue 1333)
Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) are common causes of peptic ulcer disease. Patients infected with Helicobacter pylori who take aspirin or another NSAID have an especially high risk.  Drugs that have been tried for prevention of ulcers in patients taking NSAIDs including H2-receptor antagonists, proton pump inhibitors (PPIs), aluminum- or...
The Medical Letter on Drugs and Therapeutics • January 25, 2010 (Issue 1330)
Once thought to be a beneficial response to critical illness, hyperglycemia is now recognized as independently associated with death and other adverse outcomes in various groups of critically ill patients. Whether normalization of blood glucose by insulin infusion is beneficial in such patients has been a subject of debate in the critical care community. Some new guidelines have been published....
The Medical Letter on Drugs and Therapeutics • December 14, 2009 (Issue 1327)
Conflicting recommendations on when to screen for breast cancer are problematic for healthcare providers. The recent recommendation by the US Preventive Services Task Force (USPSTF) against routine screening mammography for women 40-49 years old conflicts with recommendations made by other organizations such as the American Cancer Society and earlier recommendations made by the USPSTF in 2002....
The Medical Letter on Drugs and Therapeutics • June 15, 2009 (Issue 1314)
A 23-valent polysaccharide vaccine (PPSV23; Pneumovax 23 - Merck) is the only pneumococcal vaccine approved for use in adults. It has reduced the risk of invasive pneumococcal disease (meningitis or bacteremic pneumonia), but not mortality, in immunocompetent older adults.2 PPSV23 has not been shown to reduce the risk of invasive pneumococcal disease (IPD) in immunocompromised patients....
The Medical Letter on Drugs and Therapeutics • May 4, 2009 (Issue 1311)
The recent Medical Letter article on vancomycin dosing and monitoring briefly mentioned use of an alternative antibiotic for treatment of methicillin-resistant Staphylococcus aureus (MRSA) with reduced susceptibility to vancomycin. Some readers have asked for more information on this subject.

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The Medical Letter on Drugs and Therapeutics • December 15, 2008 (Issue 1301)
Many drugs can cause psychiatric symptoms, but a causal connection is often difficult to establish. Psychiatric symptoms that emerge during drug treatment could also be due to the underlying illness, previously unrecognized psychopathology, or psychosocial factors. The withdrawal of some drugs can cause symptoms such as anxiety, psychosis, delirium, agitation or depression.

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The Medical Letter on Drugs and Therapeutics • November 17, 2008 (Issue 1299)
Depression occurs in up to 20% of pregnant women, and the use of selective serotonin reuptake inhibitors (SSRIs) in these women has been increasing. Maternal depression has itself been associated with intrauterine growth problems and low birth weight, so the risks of exposure to antidepressants during pregnancy must be weighed against the risks of untreated depression, which also include self-...
The Medical Letter on Drugs and Therapeutics • September 8, 2008 (Issue 1294)
Sunscreens are an important component of photoprotection. A new definition of their effectiveness has been proposed, and some issues have arisen concerning their safety.

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The Medical Letter on Drugs and Therapeutics • November 19, 2007 (Issue 1274)
Direct-to-consumer advertisements are urging women to be tested for mutations in BRCA1 and BRCA2 genes, which are the most common known causes of an inherited predisposition to breast and ovarian cancer. Clinically important BRCA mutations have been found in about 2% of Ashkenazi Jewish women, and are estimated to occur in about 1 in 300 to 500 women in the general non-Jewish US...
The Medical Letter on Drugs and Therapeutics • December 5, 2005 (Issue 1223)
Many patients planning to travel seek advice about prevention of malaria. No drug is 100% effective for this indication; travelers should be told to take other protective measures as well. Malaria in pregnancy is particularly serious for both mother and fetus; prophylaxis is indicated if travel cannot be avoided. Countries with a risk of malaria are listed in the table on page 102. Some countries...
The Medical Letter on Drugs and Therapeutics • June 6, 2005 (Issue 1210)
Picaridin (KBR 3023), which has been used as an insect repellent for years in Europe and Australia (Autan Repel, and others), is now available in the US in 7% solution as Cutter Advanced (Spectrum Brands). The US Centers for Disease Control and Prevention (CDC) is recommending it as an alternative to DEET.

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The Medical Letter on Drugs and Therapeutics • June 7, 2004 (Issue 1184)
Solar ultraviolet (UV) light capable of injuring the skin is classified by wavelength into UVA I (340-400 nm), UVA II (320-340 nm) and UVB (290-320 nm). UVB is responsible for most of the erythema of sunburn. UVA has been implicated in the development of phototoxicity and photoaging. The FDA permits sunscreen manufacturers to claim broad-spectrum protection if their products block at least part...
The Medical Letter on Drugs and Therapeutics • December 8, 2003 (Issue 1171)
Questions have been raised in the US press recently about the safety of Canadian drugs. The process of drug approval in Canada is similar to that in the US (D Paul, Int J Med Marketing 2001; 1:224). More than 90% of drugs available in Canada have also been approved by the FDA. Most of these drugs come from the same manufacturers as drugs in the US. Health Canada takes longer on average to release...