High plasma homocysteine concentrations, like high cholesterol, have been associated with an increased risk of cardiovascular disease and death (O Nygσrd et al, N Engl J Med 1997; 337:230; RS Vasan et al, JAMA 2003; 289:1251). In one meta-analysis, 25% lower plasma homocysteine concentrations were associated with 11% less coronary heart disease and 19% less stroke (Homocysteine Studies Collaboration, JAMA 2002; 288:2015). Should we be trying to lower serum homocysteine concentrations in our patients?

Full-page newspaper advertisements addressed to patients with type 2 diabetes are promoting the convenience of "NEW once-a-day Glucophage XR (metformin HCl extended-release tablets),"and offering a coupon for a free 30-day supply in the month of March.

Pneumocystis carinii pneumonia (PCP) is a common cause of death in patients with acquired immune deficiency syndrome (AIDS). PCP is the first serious opportunistic infection in more than 60% of patients with AIDS, and about 80% of AIDS patients develop PCP at least once (AE Glatt et al, N Engl J Med, 318:1439, June 2, 1988). Many studies using drugs to prevent PCP in patients with AIDS have recently been reported.

Metformin (Glucophage - Bristol-Myers Squibb), a hypoglycemic agent, was recently marketed in the USA for oral treatment of patients with non-insulin-dependent diabetes mellitus (NIDDM) not adequately controlled by diet alone. Previously marketed in more than ninety countries, including Canada, metformin (dimethylbiguanide) is chemically related to phenformin (phenylethylbiguanide), which was withdrawn from the US market in 1976 because it caused a high incidence of lactic acidosis. In approving metformin, the US Food and Drug Administration stipulated that a post-marketing controlled...

View the Table: Some Drugs for Inflammatory Bowel Disease

Anticonvulsants are now widely used for treatment of psychiatric illnesses, particularly bipolar disorder. Lithium is the standard drug for treatment of bipolar disorder, but it can cause severe toxicity, serum concentrations must be monitored, and it is not effective in some patients.

Rheumatoid arthritis (RA) is prevalent in 0.5% of adults in the US; it is about 2.5 times more common in women than in men. Guidelines for treatment of RA from the American College of Rheumatology were recently updated. The goal of treatment is to minimize disease activity and prevent irreversible joint damage.

Eculizumab (Soliris - Alexion) has been approved by the FDA for reduction of hemolysis in patients with paroxysmal nocturnal hemoglobinuria (PNH), a rare form of hemolytic anemia. A recombinant humanized monoclonal antibody, eculizumab is the first drug to be marketed for this indication.

View the Comparison Table: Some Drugs for Gout

When used for the appropriate seizure type, antiseizure medications (ASMs) are roughly equivalent in efficacy. In addition to the seizure type, the choice of drug is usually based on factors such as ease of use, spectrum of activity, adverse effects, interactions with other drugs, presence of comorbid conditions, suitability for elderly persons and those with childbearing potential, and cost. Treatment should begin with a single drug, increasing the dosage gradually until seizures are controlled or adverse effects become unacceptable. If seizures persist, expert clinicians generally...