Recombinant activated coagulation factor Vll (rFVIIa; NovoSeven - Novo Nordisk), which is marketed worldwide for treatment of bleeding episodes in hemophilia patients with inhibitors to factor VIII or IX, is now being used off-label to stop bleeding in patients who do not have hemophilia. An article in the lay press reported that one or two doses has stopped previously uncontrollable bleeding due to gunshot wounds (B Wysocki, Jr, Wall St Journal, March 17, 2004, page B1).

Lenalidomide (Revlimid - Celgene), a thalidomide analog, has been approved by the FDA for treatment of patients with transfusion-dependent anemia due to myelodysplastic syndrome (MDS) associated with a 5q deletion cytogenetic abnormality and a low or low-intermediate risk of mortality and progression to leukemia (based on the International Prognostic Scoring System).

The FDA has approved vorapaxar (Zontivity – Merck), an oral protease-activated receptor-1 (PAR-1) antagonist, for use with aspirin and/or clopidogrel to reduce the risk of thrombotic cardiovascular events in patients with peripheral arterial disease or a history of myocardial infarction (MI). It is the first PAR-1 antagonist to be approved by the FDA.

The FDA has approved miltefosine (Impavido – Knight Therapeutics), an oral alkylphosphocholine analog, for treatment of visceral, cutaneous, and mucosal leishmaniasis caused by some Leishmania species. It is the first drug to be approved by the FDA for treatment of cutaneous and mucosal leishmaniasis and the first oral drug to be approved for treatment of visceral leishmaniasis.

The FDA has approved droxidopa (Northera – Lundbeck) for oral treatment of adults with symptomatic neurogenic orthostatic hypotension (NOH) caused by primary autonomic failure (Parkinson's disease, multiple system atrophy, or pure autonomic failure), dopamine beta-hydroxylase deficiency, or nondiabetic autonomic neuropathy. This is the first approval for droxidopa in the US. It has been available in Japan for use in NOH since 1989.

The FDA has approved iDose TR (Glaukos), an intracameral implant containing the prostaglandin analog (PGA) travoprost, for reduction of intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension. Travoprost is also available as a topical ophthalmic solution (Travatan Z, and generics) for the same indication. iDose TR is the second ocular implant to become available in the US for this indication; Durysta, an intracameral implant containing the prostaglandin analog bimatoprost, was the first.

Acute toxic reactions to drugs of abuse continue to be important problems. Some patients may have mixed intoxications with complex combinations of signs and symptoms.

The FDA has approved Suflave (Sebela/Braintree), a low-volume polyethylene glycol (PEG)- and sulfate-based product for cleansing of the colon prior to colonoscopy in adults. Other oral colonoscopy preparations available in the US are listed in Table 2. Suflave is marketed as tasting better than other products.

Some commonly used systemic drugs that may cause pulmonary toxicity are listed in the table below. These adverse effects may sometimes be difficult to distinguish from the underlying disease (JAD Cooper, Jr et al, Am Rev Respir Dis, 133:321, 488, 1986). Pulmonary effects that are part of a generalized reaction or are indirect effects of drugs - on respiratory muscles, for example, or on the immune system - are not included here.

Pregnant women now often receive promotional material from private cord blood banks urging them to save and store their babies' cord blood.