Flosequinan (Manoplax - Boots), a fluoroquinolone derivative, is now available in the USA for treatment of congestive heart failure. Labeling approved by the US Food and Drug Administration recommends the drug only for patients who cannot tolerate or have not responded adequately to an angiotensin-converting enzyme (ACE) inhibitor.

Terazosin (Hytrin - Abbott), a postsynaptic alpha 1 -adrenoreceptor blocker previ-ously available for treatment of hypertension (Medical Letter, 29:113, 1987), has now been approved by the US Food and Drug Administration (FDA) for treatment of benign prostatic hyperplasia (BPH). Although not previously approved by the FDA, terazosin and other alpha-blockers such as prazosin (Minipress, and others) or doxazosin (Car-dura) have been used for this indication for many years.

Recombinant human deoxyribonuclease I (rhDNase; dornase alfa; Pulmozyme - Genentech), an enzyme that hydrolyzes extracellular DNA, is now available as a purified solution to decrease the viscosity of sputum in patients with cystic fibrosis. It requires a nebulizer to produce an aerosol mist for inhalation.

Aprotinin (Trasylol - Miles), an inhibitor of fibrinolysis first identified in 1930, was recently approved by the US Food and Drug Administration for intravenous use in high-risk coronary artery bypass graft (CABG) surgery to decrease bleeding and the need for transfusion. Inhibitors of fibrinolysis previously available in the USA include aminocaproic acid (Amicar, and others) and tranexamic acid (Cyklokapron - Medical Letter, 29:89, 1987).

Mycophenolate mofetil (CellCept - Roche) has been approved by the US Food and Drug Administration for oral use in preventing organ rejection in patients receiving allogeneic renal transplants. It is being promoted as an improvement over azathioprine (Imuran) for concurrent use with cyclosporine (Sandimmune; Neoral) and corticosteroids.

Recent articles in the press have suggested that in early pregnancy, an intramuscular (IM) injection of methotrexate (Folex, and others), a folic acid antagonist, and oral or vaginal administration of misoprostol (Cytotec), a prostaglandin, offers a medical alternative to a surgically induced abortion. Methotrexate is approved by the US Food and Drug Administration for use in rheumatoid arthritis, psoriasis and various types of cancer, including choriocarcinoma, and has also been used to terminate ectopic pregnancies. Misoprostol is approved for prevention of gastric ulcers induced by...

Anastrozole (Arimidex - Zeneca), a selective nonsteroidal aromatase inhibitor, has been approved by the US Food and Drug Administration (FDA) for treatment of postmenopausal women with advanced breast cancer that has progressed during treatment with tamoxifen (Nolvadex, and others).

Alteplase, a recombinant tissue plasminogen activator (TPA; Activase - Genentech), has been approved by the US Food and Drug Administration (FDA) for intravenous (IV) treatment of acute ischemic stroke. Several thrombolytic agents, including alteplase, were previously approved for use in acute myocardial infarction and acute massive pulmonary embolism (Medical Letter, 29:107, 1987; 32:15, 1990).

Sodium phenylbutyrate, an "orphan drug,"has recently been marketed for the treatment of patients with urea cycle disorders caused by a deficiency in one of the following hepatic enzymes: carbamyl phosphate synthetase (CPS), ornithine transcarbamylase (OTC), or argininosuccinic acid synthetase (AS). Urea cycle disorders are rare; they occur in one of every 10,000 births.

Imiquimod (i mi kwi' mod) 5% cream (Aldara - 3M Pharmaceuticals) has been approved by the FDA for treatment of external genital and perianal warts (condyloma acuminata). The drug requires a prescription but is applied by the patient. It is the second patient-applied treatment to become available for external genital warts; the first was podofilox (Condylox - Medical Letter, 33:117, 1991).