Propafenone (Rythmol - Knoll), a class IC antiarrhythmic drug used in Europe for treatment of various arrhythmias for more than 10 years, was recently marketed in the USA for oral treatment of life-threatening ventricular arrhythmias such as sustained ventricular tachycardia. This restrictive labeling reflects concerns arising from the interim report of the Cardiac Arrhythmia Suppression Trial, in which post-myocardial infarction patients with asymptomatic or mildly symptomatic ventricular arrhythmias treated with the class IC antiarrhythmic drugs encainide (Enkaid) or flecainide...

Botulinum toxin Type A (Oculinum - Allergan), used investigationally for many years to treat ocular muscle disorders (Medical Letter, 29:101, 1987), has now been approved by the US Food and Drug Administration for intramuscular treatment of strabismus and blepharospasm in patients more than 12 years old.

Felodipine (Plendil - Merck), an extended-release preparation of a dihydropyridine calcium-channel blocker was recently marketed in the USA for oral treatment of hypertension. An immediate-release formulation is available in some other countries.

Capsaicin, a vanillyl alkaloid found in hot peppers and related plants, is now available without a prescription as Zostrix-HP (GenDerm) for topical relief of pain due to diabetic neuropathy, herpes zoster, or arthritis. The new formulation contains 0.075% capsaicin; the drug was previously available in a 0.025% concentration as Zostrix.

Flecainide (Tambocor -3M Pharmaceuticals), first introduced in 1985 for treatment of ventricular arrhythmias, was recently approved by the US Food and Drug Administration for oral use to prevent supraventricular arrhythmias. The indications for using flecainide to treat ventricular arrhythmias were limited after a controlled trial found that post-myocardial infarction patients with asymptomatic ventricular arrhythmias who took the drug had twice as high a mortality rate as patients who took placebo (DS Echt et al, N Engl Med, 324:781, 1991).

Pentostatin (2'-deoxycoformycin; DCF; - Parke-Davis), a purine analog, was recently approved by the US Food and Drug Administration (FDA) for treatment of hairy-cell leukemia resistant to interferon alfa (Intron A; Roferon-A). is a rare (500 cases/year in the USA) form of chronic lymphocytic leukemia. Acutely ill patients may respond rapidly to interferon, but the drug is rarely curative. Another purine analog, 2-chlorodeoxyadenosine (CdA; Leustatin - Ortho Biotech), may also be approved soon for treatment of hairy-cell leukemia (JD Piro, Blood, 79:843, 1992). Fludarabine (Fludara...

Rifabutin (formerly ansamycin; Mycobutin - Adria), a rifamycin antibiotic similar to rifampin (Rifadin, Rimactane) was recently approved by the US Food and Drug Administration for prevention of disseminated Mycobacterium avium complex (MAC) disease in patients with advanced HIV infection.

Fentanyl, a synthetic opioid previously available for parenteral use in anesthesia (Sublimaze, and others) and in a transdermal patch for chronic pain (Duragesic - Medical Letter, 34:97, 1992), has now also been marketed as a raspberry-colored lozenge on a plastic handle (Fentanyl Oralet - Abbott), which resembles a lollipop. The new formulation will probably be promoted mainly for premedication of children before anesthesia, but has also been approved by the US Food and Drug Administration (FDA) for preanesthetic use in adults and for use in anesthesia or 'monitored anesthesia care' in...

Captopril (Capoten - Bristol-Myers Squibb), an angiotensin-converting enzyme (ACE) inhibitor previously available for treatment of hypertension, has now been approved by the US Food and Drug Administration (FDA) for treatment of diabetic nephropathy in patients with insulin-dependent diabetes mellitus (IDDM). Diabetic nephropathy is the most common cause of end-stage renal disease in the United States.

Two products combining conjugated estrogens with medroxyprogesterone acetate (Prempro and - Wyeth-Ayerst) were recently approved for marketing by the US Food and Drug Administration. Both combine in one package tablets of Premarin, a conjugated equine estrogen product, with tablets of Cycrin, a medroxyprogesterone acetate brand. With Prempro, both tablets are taken daily continuously; with Premphase, the estrogen is taken daily, but the progestin is taken sequentially on days 15 through 28 of each 28-day cycle.