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).

Immune-mediated hemolysis is a rare adverse effect of second- and third-generation cephalosporins, especially cefotetan (Cefotan) (PA Arndt et al, Transfusion 1999; 39:1239). A recent report serves as a reminder that life-threatening immune-mediated hemolysis rarely can follow administration of ceftriaxone (Rocephin), one of the most commonly used parenteral antibiotics in the US (A Citak et al, J Paediatr Child Health 2002; 38:209).

Yttrium-90 ibritumomab tiuxetan (Zevalin -IDEC) was approved by the FDA for treatment of patients with relapsed or refractory low-grade follicular or transformed B-cell non-Hodgkin's lymphoma (NHL), including patients with follicular lymphoma refractory to rituximab (Rituxan -Medical Letter 1998; 40:65). Zevalin is the first radioimmunoconjugate to be approved for treatment of cancer.

Valacyclovir (Valtrex - GlaxoSmithKline) was recently approved by the FDA for one-day oral treatment of patients at least 12 years old with orolabial herpes simplex infections. The drug was previously approved for treatment and suppression of genital herpes and for treatment of herpes zoster (shingles).

Rasburicase (Elitek - Sanofi-Synthelabo), a recombinant form of urate oxidase derived from the fungus Aspergillus flavus, has been approved by the FDA for intravenous (IV) management of hyperuricemia associated with tumor lysis syndrome in pediatric patients.

An FDA panel has recommended that stronger warnings about hepatotoxicity be added to the labeling for acetaminophen (www.fda.gov, search "acetaminophen hepatotoxicity").

A once-weekly 35-mg oral formulation of the bisphosphonate risedronate (Actonel) has been approved by the FDA for prevention and treatment of postmenopausal osteoporosis. A once-weekly formulation of alendronate (Fosamax) was approved last year (Medical Letter 2001; 43:26). Bisphosphonates bind to the mineral surface of bone and decrease osteoclast activity, inhibiting the resorption phase of the bone turnover cycle. These drugs are not metabolized and remain bound to bone for several weeks.

Three beta interferons are widely used in the treatment of patients with relapsing-remitting multiple sclerosis (RRMS).

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?

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.