Many women of child-bearing age now take folic acid supplements of 400 ╡g per day to prevent neural tube defects in their offspring (Medical Letter 1998; 40:75). An FDA advisory committee has recommended development of a combination tablet containing an oral contraceptive and 400 ╡g of folic acid. A recent editorial in the New England Journal of Medicine suggested that folic acid doses should be higher (NJ Wald, N Engl J Med 2004; 350:101).

Six years after an FDA advisory committee recommended development of a combination tablet containing an oral contraceptive and folic acid,1 the FDA has approved Beyaz (Bayer), a combination of the oral contraceptive Yaz2 with 451 mcg of levomefolate calcium, the primary metabolite of folic acid.3 According to the FDA, an unpublished double-blind, randomized U.S. trial in 379 healthy women 18-40 years old found that the combination increased serum folate levels. In an unpublished German study using a similar oral contraceptive/ levomefolate combination (summarized in the package insert), folate...

Many patients ask their healthcare providers whether they should take vitamins. Since the last Medical Letter article on this subject, more data have become available on the benefits and risks of taking vitamins.

Many patients ask their physicians whether they should take vitamins. Since the last Medical Letter article on this subject, more data have become available on the benefits and risks of taking vitamin supplements.

Betaine (Cystadane - Orphan Medical), an orphan drug, has recently been marketed for treatment of homocystinuria, a genetic disorder. Patients with homocystinuria frequently have premature atherosclerosis and thromboembolism, and may also have lens dislocations, skeletal abnormalities and mental retardation (SH Mudd et al in CR Scriver et al, eds, The Metabolic and Molecular Bases of Inherited Disease, 7th ed, New York:McGraw Hill, 1995, page 1279).

View Expanded Table: Some Conventional DMARDs for Rheumatoid Arthritis

L-methylfolate (Deplin — Pamlab) is a “medical food” marketed for adjunctive use in depression or schizophrenia in patients with suboptimal folate levels. It is available only by prescription.

Recent articles in the press have suggested that in early pregnancy, an intramuscular (IM) injection of methotrexate (Folex, and others), a folic acid antagonist, and oral or vaginal administration of misoprostol (Cytotec), a prostaglandin, offers a medical alternative to a surgically induced abortion. Methotrexate is approved by the US Food and Drug Administration for use in rheumatoid arthritis, psoriasis and various types of cancer, including choriocarcinoma, and has also been used to terminate ectopic pregnancies. Misoprostol is approved for prevention of gastric ulcers induced by...

The combination of pemetrexed (Alimta - Lilly) and cisplatin is the first chemotherapy regimen approved by the FDA for treatment of malignant pleural mesothelioma. This uncommon malignancy, which has been linked to asbestos exposure, was previously considered unresponsive to chemotherapy, with a median survival of 6-8 months from diagnosis (VW Rusch, J Clin Oncol 2003; 21:2629).

View the Table: Safety of Drugs for IBD in Pregnancy