Nizatidine (Axid - Lilly), a new H2-receptor antagonist similar to cimetidine (Tagamet), ranitidine (Zantac) and famotidine (Pepcid), was recently approved by the US Food and Drug Administration for treatment of active duodenal ulcer and for maintenance therapy after healing. Cimetidine, ranitidine and famotidine are also approved for treatment of pathological hypersecretory conditions such as Zollinger- Ellison syndrome; cimetidine is approved in addition for treatment of gastric ulcers.

Patients may be asking their physicians about use of histamine H2-receptor antagonists for treatment and prevention of heartburn. Cimetidine and famotidine have recently been released for over-the-counter sale and are being heavily advertised on television and in the print media.

View the Inhibitors and Inducers of CYP Enzymes, P-Glycoprotein, and Other Transporters tables

View the Comparison Table: H2-Receptor Antagonists and PPIs

Cisapride (Propulsid - Janssen), a piperidinyl benzamide prokinetic drug, is now available in the USA for symptomatic relief of nocturnal heartburn due to gastroesophageal reflux disease. In Canada, cisapride is also marketed for treatment of gastroparesis.

The FDA has asked the manufacturers of the selective serotonin reuptake inhibitor (SSRI) antidepressant citalopram (Celexa, and others) to revise the labeling of the drug to include new warnings about the risk of QT interval prolongation.

Methadone, an opioid agonist that can be taken orally, has been used for maintenance treatment for many years in the USA (DM Novick et al, Drug Alcohol Depend, 33:235, 1993). Last year, the US Food and Drug Administration approved the distribution and use of L-alpha-acetyl-methadol (LAAM; ORLAAM - Bio Development Corporation, McLean, VA), a long-acting congener of methadone. LAAM, like methadone, will be available for this indication only through federal and state-regulated treatment programs.

Donepezil hydrochloride (Aricept - Eisai), a piperidine-based acetylcholinesterase inhibitor, is now being marketed for oral treatment of cognitive symptoms in patients with mild to moderate dementia due to Alzheimer's disease. Donepezil is the second drug approved for this indication; tacrine hydrochloride (Cognex), also an acetylcholinesterase inhibitor, has been available in the USA for four years (Medical Letter, 35:87, 1993).

Misoprostol (Cytotec - Searle), a synthetic methyl analog of prostaglandin E1, was recently approved by the US Food and Drug Administration for prevention of gastric ulcers in high-risk patients taking nonsteroidal anti-inflammatory drugs (NSAIDs). In other countries, the drug is also marketed for treatment of idiopathic peptic ulcers unrelated to NSAIDs.

Estazolam (ProSom - Abbott), a triazolobenzodiazepine derivative similar in structure to alprazolam (Xanax) and triazolam (Halcion), was recently marketed in the USA for treatment of insomnia.