Medical Letter consultants have brought to our attention some confusion that has accompanied the release of Adacel, a combination of tetanus toxoid, diphtheria toxoid and acellular pertussis antigens (Tdap) recently approved for use as a booster in adolescents and adults 11-64 years old (Med Lett Drugs Ther 2006; 48:5). Another Tdap vaccine, Boostrix, is approved for use in adolescents 10-18 years old. Some adults have inadvertently been immunized with Daptacel or Infanrix (DTaP), which are intended for active immunization of infants and children 6 weeks to 6 years old. Such mix-ups were...

A recent article in the New England Journal of Medicine confirms something that others, including The Medical Letter (Treat Guidel Med Lett 2008; 6:23), have been saying for years: no particular combination of protein, carbohydrate and fat in the diet offers any advantage in losing weight. This randomized 2-year trial followed 800 overweight and obese subjects on low fat/average protein, low fat/high protein, high fat/average protein, and high fat/high protein diets. Carbohydrate intake varied from 35% (in the high fat/high protein diet) to 65% (in the low fat/average protein diet). All...

Escitalopram (Lexapro - Forest), the active S-enantiomer of racemic citalopram (Celexa - Forest), a selective serotonin reuptake inhibitor (SSRI), was recently approved by the FDA for treatment of depression. The manufacturer plans to stop promoting Celexa in favor of Lexapro; Celexa will continue to be available for patients already taking it.

There is no longer any doubt that an implantable cardioverter defibrillator (ICD) can reliably terminate most life-threatening ventricular tachyarrhythmias. The remaining question is who should get one. Guidelines prepared by an American College of Cardiology/American Heart Association task force have recently been published (G Gregoratos et al, Circulation 2002; 106:2145).

Use of a selective serotonin reuptake inhibitor (SSRI) is common in women taking tamoxifen (Nolvadex, and others) for breast cancer, both to treat depression and to decrease hot flashes. However, tamoxifen must be metabolized by CYP2D6 to become pharmacologically fully active (MJ Higgins et al. J Natl Compr Canc Netw 2009; 7:203), and the SSRIs fluoxetine (Prozac, and others) and paroxetine (Paxil, and others) are strong inhibitors of CYP2D6. Sertraline (Zoloft, and others) inhibits CYP2D6 to a lesser extent. Citalopram (Celexa, and others) and escitalopram (Lexapro), the 2 other SSRIs...

A Medical Letter subscriber was surprised to discover that a new Citracal product contained not only calcium citrate, but also calcium carbonate. Citracal Plus Bone Density Builder actually contains more calcium carbonate per tablet than calcium citrate (240 mg vs. 60 mg). Another Citracal product, Citracal Plus Heart Health, also contains more calcium carbonate than calcium citrate. Many clinicians prefer calcium citrate because it can be taken with or without food, while calcium carbonate must be taken with food for optimal absorption. Other familiar over-the-counter (OTC) names also contain...

When patents expire on brand-name drugs and generic formulations become available, patients and managed care organizations may express a preference for the lower-cost generics. Are they equivalent to the brand-name product?

Methamphetamine, a highly addictive synthetic sympathomimetic, has again become important as a drug of abuse in the US. Its resurgence has been associated with unsafe sexual practices that have resulted in an increase in HIV transmission, particularly among men who have sex with men (SJ Semple et al, J Subst Abuse Treat 2002; 22:149; A Urbina and K Jones, Clin Infect Dis 2004; 38:890).

Alefacept (a le' fa sept; Amevive - Biogen) has been approved by the FDA for parenteral treatment of adults with moderate to severe chronic plaque psoriasis.

Advertisements are appearing in medical journals for continuing medical education courses on catheter ablation of atrial fibrillation. Is a cure at hand for this common disorder?