Photopheresis is a new technique recently approved by the US Food and Drug Administration for treatment of cutaneous T-cell lymphoma. It combines oral administration of a photoactivatable cytotoxic drug with leukapheresis and extracorporeal exposure of leukocytes to long-wave ultraviolet light (UVA). This procedure requires use of a 'UVAR Instrument' manufactured by Therakos, a subdivision of Johnson and Johnson.

Flutamide (Eulexin - Schering), an oral antiandrogen, is now available in the USA for treatment of metastatic prostate cancer. Flutamide is recommended by the manufacturer only for use concurrently with an analog of luteinizing hormone-releasing hormone (LHRH) such as leuprolide (Lupron - Medical Letter, 27:71, 1985).

High doses of various hormones have been used for many years to prevent pregnancy after unprotected coitus. Diethylstilbestrol (DES), a synthetic estrogen, was once approved for this purpose by the US Food and Drug Administration (Medical Letter 15:58, 1973), but no drug is now approved for such use. Ovral, an oral contraceptive containing 50 g of the estrogen ethinyl estradiol and 0.5 mg of the progestin norgestrel, has been recommended as a 'morning-after' pill by some physicians (RA Hatcher et al, Contraceptive Technology 1988-1989, 14th ed., New York:Irvington, 1988, page...

Lepirudin (Refludan - Hoechst Marion Roussel), a direct inhibitor of thrombin, has been approved by the FDA for use as an anticoagulant in patients with heparin-induced thrombocytopenia and thromboembolic complications.

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

The FDA has approved the use of a transcutaneous electrical nerve stimulation device (Cefaly – Cefaly Technology) for prevention of episodic migraine in patients ≥18 years old. The first device to be approved in the US for migraine prevention, it is available in Canada and Europe for treatment and prevention of migraines. A transcranial magnetic stimulation device (SpringTMS - eNeura Therapeutics) recently approved by the FDA for treatment of migraine preceded by aura will be reviewed in a future issue.

The FDA has approved an inhalation solution formulation of the long-acting antimuscarinic agent (LAMA) glycopyrrolate (Lonhala Magnair – Sunovion) for maintenance treatment of chronic obstructive pulmonary disease (COPD). The new formulation is delivered using a portable, handheld, electronic nebulizer. Glycopyrrolate is also available as a dry powder inhaler, both alone (Seebri Neohaler) and in combination with indacaterol (Utibron Neohaler), and as a metered-dose inhaler in combination with formoterol (Bevespi Aerosphere). Lonhala Magnair is the first nebulized LAMA to become...

Some classes of drugs include so many agents that hospital formulary committees, managed care organizations and individual practitioners may find it difficult to choose among them. Fifteen beta-adrenergic receptor antagonists (beta-blockers) are now marketed for systemic use in the USA. One or more have been approved by the FDA for use in hypertension and eight other indications.

Two combinations of an inhaled corticosteroid with an inhaled long-acting beta2-agonist are approved by the FDA for use in patients with COPD: fluticasone/salmeterol (Advair Diskus) and budesonide/formoterol (Symbicort). A Medical Letter reader has questioned the safety of using corticosteroid inhalers in patients with this disorder. No single-agent inhaled corticosteroid inhaler is approved for this indication.

The Immunization Practices Advisory Committee of the US Public Health Service now recommends immunizing all infants and some adolescents against hepatitis B and using a new diphtheria-tetanus-acellular pertussis vaccine (DTaP; ACEL-IMUNE - Lederle) for the fourth and fifth doses of DTP, usually given at 15 to 18 months of age and before school entry (Morbid Mortal Weekly Rep, 40 RR-13:1, November 22, 1991; Morbid Mortal Weekly Rep, 41 RR-1:1, Feb 7, 1992). The Committee on Infectious Diseases of the American Academy of Pediatrics has made similar recommendations but would extend...