Nafarelin acetate (Synarel - Syntex), a synthetic analog of gonadotropin-releasing hormone (GnRH), was recently approved by the US Food and Drug Administration for treatment of endometriosis. The drug is available only in a nasal spray formulation.

Antibiotic treatment of group A streptococcal pharyngitis can relieve symptoms, limit transmission of infection, and prevent suppurative and nonsuppurative sequelae. Clinical findings may be unreliable, however, in establishing the diagnosis, and conventional throat cultures take overnight or longer to produce results. Rapid office tests for streptococcal pharyngitis can make the diagnosis in about 10 minutes. Since the previous Medical Letter article on this subject (Medical Letter, 27:49, 1985), many new tests have been marketed, including some that use new technologies.

Bepridil hydrochloride (Vascor - McNeil Pharmaceutical/Wallace Laboratories), a calcium-channel blocking agent chemically unrelated to verapamil (Calan, and others), nifedipine (Procardia, and others), or other drugs in this class, was recently approved by the US Food and Drug Administration for oral treatment of chronic stable angina pectoris. Because of its potential adverse effects, the labeling recommends reserving the drug for patients who fail to respond optimally to or are intolerant of other antianginal agents.

HA-1A (Centoxin - Centocor), a monoclonal IgM antibody against endotoxin from gram-negative bacteria, may soon be approved for marketing by the US Food and Drug Administration. Commercially available in Europe, HA-1A has been used in the USA as an investigational drug. E5 (Xomen - Xoma), another monoclonal IgM antibody against endotoxin, is also available here for investigational use.

hydrochloride (Ticlid - Syntex), a platelet aggregation inhibitor that has been available in Europe for more than a decade, was recently approved by the U.S. Food and Drug Administration to decrease the risk of thrombotic stroke in men and women who have had premonitory signs of stroke or have had a completed thrombotic stroke. The manufacturer is promoting the drug for patients intolerant to aspirin or with conditions for which aspirin has not been approved (previous thrombotic stroke; transient ischemic attacks in women). The drug has also been used for prevention of myocardial ...

Tramadol hydrochloride (Ultram - Ortho-McNeil), a centrally-acting analgesic marketed in Germany since 1977, was recently approved by the US Food and Drug Administration for oral treatment of moderate to moderately severe pain. Despite some opioid activity, tramadol has not been scheduled as a controlled substance.

Topical tretinoin (all-trans-retinoic acid) has been used for years to treat skin damaged by chronic exposure to the sun (Medical Letter, 34:28, 1992). First approved by the FDA only for treatment of acne in concentrations ranging from 0.025% to 0.1% (Retin-A, and others), it has now been approved as an 0.05% formulation in an emollient cream base (Renova) for topical treatment of photodamaged skin. In recent years, alpha-hydroxy acids incorporated in some cosmetics have also been promoted as effective in improving the appearance of aging skin.

Creatine, a natural amino acid derivative, and androstenedione, a testosterone precursor, are marketed as 'dietary supplements' in health food stores and are widely believed to enhance athletic performance. Both have been in the news recently because Mark McGwire, the baseball home-run record-setter, reportedly has said he takes both. Neither has been approved for any indication by the US Food and Drug Administration (FDA).

Entacapone (Comtan), a catechol-O-methyltransferase (COMT) inhibitor, has been approved by the FDA for adjunctive use with levodopa/carbidopa in patients with Parkinson's disease who have end-of-dose "wearing off"symptoms.

Phytoestrogens, plant compounds that are converted to estrogens in the gut, are widely promoted as "natural"substitutes for estrogen in hormone replacement therapy.