The Reflotron (Boehringer Mannheim), a desk-top colorimetric reflectance analyzer that weighs 12 pounds, can do clinical chemistry tests on 30 l of whole blood, plasma or serum, using multilayered strips containing dry chemicals. A single test takes two to three minutes.

The Medical Letter recently reviewed a topical gel formulation of testosterone (Fortesta) for treatment of hypogonadism in men. A topical testosterone replacement product for application to the axilla, Axiron (Lilly) solution, has now become available for the same indication. This site of application presumably minimizes the risk of transferring the drug to a family member or sexual partner.

Major orthopedic surgery creates a prothrombotic state by causing tissue injury during the operation and requiring relative immobilization during recovery. Without thromboprophylaxis, 40-60% of patients undergoing major knee or hip surgery develop venographically detectable deep vein thrombosis (DVT) and 1 in 300 undergoing total hip replacement will have a symptomatic pulmonary embolism (PE). Thromboprophylaxis reduces the incidence of venous thromboembolism (VTE), but it also can cause bleeding. New guidelines for prevention of VTE have recently been published.

Dalteparin (Fragmin - Pharmacia), the second low-molecular-weight heparin to be marketed in the USA, is now available for prevention of deep vein thrombosis in high-risk patients after abdominal surgery. Enoxaparin (Lovenox -Rh ne-Poulenc Rorer) was approved in 1993 for prevention of deep vein thrombosis after hip replacement (Medical Letter, 35:75, 1993) and later approved for use in knee replacement. Five other low-molecular-weight heparins and one heparinoid are under investigation in the USA (MJ Cziraky and SA Spinler, Clin Pharm, 12:892, 1993).

Tolcapone (Tasmar - Roche), a dihydroxy-methyl-nitrobenophenone, has been marketed as an adjunct to levodopa/carbidopa (Sinemet, and others) for treatment of Parkinson's disease in both stable patients and those with end-of-dose "wearing off"of levodopa.

An intranasal formulation of ketorolac tromethamine (Sprix – Lutipold) has been approved by the FDA for short-term (up to 5 days) treatment of moderate to moderately severe pain in adults. It is the first nonsteroidal anti-inflammatory drug (NSAID) to become available in an intranasal formulation. Ketorolac tromethamine is also available in oral, ophthalmic and injectable formulations.

Transcatheter aortic-valve replacement (TAVR), a procedure in which a prosthetic valve is inserted into the aortic annulus by a catheter, has been approved by the FDA as an alternative to surgical aortic-valve replacement for patients with severe symptomatic aortic stenosis who are considered inoperable.

Results from a double-blind trial suggest that off-label use of the oral antihyperglycemic drug metformin in patients with COVID-19 may decrease the risk of post-acute sequelae of SARS-CoV-2 infection ("long COVID").

Moricizine (mor i'; siz een) hydrochloride (Ethmozine - Du Pont), a class I antiarrhythmic drug developed in the USSR, was recently approved by the US Food and Drug Administration (FDA) for oral treatment of life-threatening ventricular arrhythmias.

An intravenous formulation of amiodarone (Cordarone IV -Wyeth-Ayerst) has been approved by the US Food and Drug Administration (FDA) for treatment and prophylaxis of recurrent ventricular fibrillation (VF) or hemodynamically unstable ventricular tachycardia (VT) in patients refractory to other therapy.