The FDA has approved a new injectable formulation of methotrexate (Otrexup – Antares) for use in rheumatoid arthritis and polyarticular juvenile idiopathic arthritis, and for severe psoriasis in adults. On its web site (www.otrexup.com), the manufacturer states: "Otrexup is the first subcutaneous (SC) methotrexate (MTX) for self-administration delivered once weekly by auto-injector." Methotrexate has been available as a once-weekly injection (IM or SC) for these indications for many years,1 but not specifically for self-administration and not in a single-dose auto-injector. Methotrexate is...

Combining a statin with another drug that lowers low-density lipoprotein cholesterol (LDL-C), such as colesevelam (Welchol), niacin (Niaspan, and others), or ezetimibe (Zetia), can reduce LDL-C levels more than a statin alone, but studies convincingly demonstrating that such combinations improve clinical outcomes have been lacking. The results of a long-term randomized, double-blind clinical trial (IMPROVE-IT) recently presented at the American Heart Association's Scientific Sessions 2014 indicate that addition of ezetimibe to simvastatin in high-risk patients reduces cardiovascular...

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.

Advertisements for atorvastatin (Lipitor), the market leader facing generic competition, have been in the news recently in the US. Lovastatin, pravastatin and simvastatin are all available generically at a much lower retail price or lower co-pay than atorvastatin.

The FDA has approved lacosamide (Vimpat - UCB Pharma) for oral or intravenous (IV) use as add-on therapy in adults with partial-onset seizures.

View the Comparison Table: Some Drugs for Gout

Clostridioides (formerly Clostridium) difficile infection (CDI) is the most common infectious cause of healthcare-associated diarrhea in adults. Guidelines on management of CDI have recently been updated.

Tretinoin (all-trans-retinoic acid; Retin-A), a vitamin A metabolite used for years for topical treatment of acne, is now being used (without the approval of the US Food and Drug Administration) to improve the appearance of aging skin. Available by prescription in various concentrations in cream, gel and liquid formulations, tretinoin is chemically similar to isotretinoin (13-cis-retinoic acid; Accutane), an oral drug used for treatment of severe acne which has recently caused concern because of its teratogenicity (Morbid Mortal Weekly Rep, 37:171, March 25, 1988).

The NovolinPen (Squibb - Novo) is a device that uses prefilled cartridges to inject semisynthetic human insulin (Medical Letter, 25:63, 1983). Three formulations are available: regular insulin (Novolin R PenFill), NPH insulin isophane (Novolin N PenFill) and a mixture of 70% NPH and 30% regular (Novolin 70/30 PenFill). The NovolinPen is advertised as more accurate, more convenient and less expensive than conventional syringes and needles. The same device is marketed in Canada as the Novolin-Pen II (Connaught Novo). (An earlier device is also available as the Novolin-Pen in Canada and the...

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.