The FDA has approved an over-the-counter (OTC) 0.025% ophthalmic formulation of the selective alpha₂-adrenergic agonist brimonidine tartrate (Lumify – Bausch & Lomb) for treatment of ocular redness in adults and children ≥5 years old. Lumify is the first brimonidine product to be approved for OTC use.

Fluticasone furoate nasal spray (Veramyst - GSK) is now available for once-daily treatment of seasonal and perennial allergic rhinitis in adults and children ≥2 years old. It is similar to fluticasone propionate nasal spray (Flonase, and others), which is now available generically.

Infertility occurs in about 15% of couples. About one third of infertility is due to problems with ovulation or an anatomic abnormality of the fallopian tube or peritoneum, such as scarring, adhesions or endometriosis. Another third is due to a male infertility factor, most commonly insufficient sperm production or abnormal motility or morphology. The remaining third is unexplained. In older women unexplained infertility is probably caused by diminished quality and quantity of oocytes, decreased implantation and spontaneous pregnancy wastage.

With increasing travel, immigration, use of immunosuppressive drugs and the spread of AIDS, physicians anywhere may see infections caused by parasites. The table in this document lists first-choice and alternative drugs for most parasitic infections.

Many readers have asked the Medical Letter to evaluate St. John's wort, an herbal extract now widely sold in health food stores and pharmacies, for its effectiveness and safety in the treatment of depression. St. John's wort is licensed in Germany for treatment of anxiety, depression and insomnia. In the USA, it is considered a dietary supplement and has not been evaluated by the FDA.

A biodegradable polymer 'wafer' (Gliadel - Rh ne-Poulenc Rorer) impregnated with the alkylating agent carmustine (BCNU; Bicnu) has been marketed in the USA for local treatment of recurrent glioblastoma multiforme that requires re-operation. The dime-sized polyanhydride wafers are implanted into the surgical cavity left behind after resection. Release of the alkylating agent directly into the area of the tumor bypasses the blood-brain barrier (H Brem and R Langer, Sci Med, 3:1, 1996).

Brinzolamide (Azopt - Alcon), a thieno-thiazine-6-sulfonamide carbonic anhydrase inhibitor, has been approved by the FDA in a 1% ophthalmic suspension for treatment of elevated intraocular pressure due to ocular hypertension or open-angle glaucoma. Brinzolamide is the second FDA-approved topical carbonic anhydrase inhibitor. Dorzolamide (Trusopt) was approved earlier (Medical Letter, 37:76, 1995).

Increased resistance of pneumococci to antimicrobial drugs may encourage more extensive use of pneumococcal polysaccharide vaccine.

The US Public Health Service Advisory Committee on Immunization Practices has recently published new recommendations for prevention and control of meningococcal disease in college students.

The February 14th issue of The Medical Letter reviewed natalizumab (Tysabri - Biogen Idec), a new monoclonal antibody that was granted accelerated approval because it decreased the number of relapses in patients with multiple sclerosis. On February 28th, the FDA issued a Public Health Advisory announcing that marketing of the drug had been suspended because 2 patients who had been treated with natalizumab for more than 2 years had developed progressive multifocal leukoencephalopathy, a rare, often fatal disease...