Matching articles for "warfarin"
Treatment of Atrial Fibrillation
The Medical Letter on Drugs and Therapeutics • January 8, 2024; (Issue 1693)
Atrial fibrillation (AF) is the most common arrhythmia
in the world. Risk factor modification, anticoagulation,
rhythm control, and rate control are the four pillars
of its management. American College of...
Atrial fibrillation (AF) is the most common arrhythmia
in the world. Risk factor modification, anticoagulation,
rhythm control, and rate control are the four pillars
of its management. American College of Cardiology/American Heart Association (ACC/AHA) guidelines
on management of AF were updated recently.
Drugs for Treatment and Prevention of Venous Thromboembolism
The Medical Letter on Drugs and Therapeutics • July 25, 2022; (Issue 1655)
Anticoagulants are the drugs of choice for treatment
and prevention of deep venous thrombosis (DVT) and
pulmonary embolism (PE), collectively referred to as
venous thromboembolism (VTE). US guidelines...
Anticoagulants are the drugs of choice for treatment
and prevention of deep venous thrombosis (DVT) and
pulmonary embolism (PE), collectively referred to as
venous thromboembolism (VTE). US guidelines for
treatment of VTE were updated in 2020 and 2021.
Comparison Table: Some Oral Anticoagulants for VTE (online only)
The Medical Letter on Drugs and Therapeutics • July 25, 2022; (Issue 1655)
...
View the Comparison Table: Some Oral Anticoagulants for VTE
Turmeric Supplements
The Medical Letter on Drugs and Therapeutics • November 18, 2019; (Issue 1585)
Turmeric is a spice derived from the Curcuma longa
plant. Dietary supplements and foods containing
turmeric are widely promoted for relief of pain
and to improve joint mobility, immunity,...
Turmeric is a spice derived from the Curcuma longa
plant. Dietary supplements and foods containing
turmeric are widely promoted for relief of pain
and to improve joint mobility, immunity, digestion,
cardiovascular health, depression, anxiety, memory,
and cognition.
Drugs for Atrial Fibrillation
The Medical Letter on Drugs and Therapeutics • September 9, 2019; (Issue 1580)
Treatment of atrial fibrillation includes anticoagulation,
rate control, and rhythm control. US guidelines were
recently...
Treatment of atrial fibrillation includes anticoagulation,
rate control, and rhythm control. US guidelines were
recently updated.
Drugs for Treatment and Prevention of Venous Thromboembolism
The Medical Letter on Drugs and Therapeutics • March 12, 2018; (Issue 1542)
Anticoagulants are the drugs of choice for treatment
and prevention of deep venous thrombosis (DVT) and
pulmonary embolism (PE), collectively referred to as
venous thromboembolism (VTE). Updated US...
Anticoagulants are the drugs of choice for treatment
and prevention of deep venous thrombosis (DVT) and
pulmonary embolism (PE), collectively referred to as
venous thromboembolism (VTE). Updated US guidelines
for treatment of VTE were published in 2016.
Comparison Table: Some Parenteral Anticoagulants for VTE (online only)
The Medical Letter on Drugs and Therapeutics • March 12, 2018; (Issue 1542)
...
View the Comparison Table: Some Parenteral Anticoagulants for VTE
Comparison Table: Some Oral Anticoagulants for VTE (online only)
The Medical Letter on Drugs and Therapeutics • March 12, 2018; (Issue 1542)
...
View the Comparison Table: Some Oral Anticoagulants for VTE
Nonopioid Drugs for Pain
The Medical Letter on Drugs and Therapeutics • February 12, 2018; (Issue 1540)
Nonopioid drugs can be used in the treatment of many
nociceptive and neuropathic pain conditions. Use of
opioids for pain will be reviewed in a future...
Nonopioid drugs can be used in the treatment of many
nociceptive and neuropathic pain conditions. Use of
opioids for pain will be reviewed in a future issue.
Drugs for GERD and Peptic Ulcer Disease
The Medical Letter on Drugs and Therapeutics • January 15, 2018; (Issue 1538)
Gastroesophageal reflux disease (GERD) is the most
frequent GI condition encountered in the outpatient
setting; it affects about 20% of the US population.
Heartburn and regurgitation are the classic...
Gastroesophageal reflux disease (GERD) is the most
frequent GI condition encountered in the outpatient
setting; it affects about 20% of the US population.
Heartburn and regurgitation are the classic symptoms
of GERD.
Betrixaban (Bevyxxa) for VTE Prophylaxis in Acute Medical Illness
The Medical Letter on Drugs and Therapeutics • January 1, 2018; (Issue 1537)
The FDA has approved betrixaban (Bevyxxa –
Portola), a once-daily, oral, direct factor Xa inhibitor,
for prophylaxis of venous thromboembolism (VTE)
in adults hospitalized for an acute medical illness
who...
The FDA has approved betrixaban (Bevyxxa –
Portola), a once-daily, oral, direct factor Xa inhibitor,
for prophylaxis of venous thromboembolism (VTE)
in adults hospitalized for an acute medical illness
who have moderately or severely restricted mobility
and other risk factors for VTE. Betrixaban is the
first oral anticoagulant to be approved in the US for
this indication.
Anticoagulation of Elderly Patients at High Risk for Falls with Atrial Fibrillation
The Medical Letter on Drugs and Therapeutics • February 27, 2017; (Issue 1515)
With the widespread adoption of the CHA2DS2-VASc
scoring system, oral anticoagulation therapy is
now recommended for all patients ≥75 years old
with nonvalvular atrial fibrillation. Atrial...
With the widespread adoption of the CHA2DS2-VASc
scoring system, oral anticoagulation therapy is
now recommended for all patients ≥75 years old
with nonvalvular atrial fibrillation. Atrial fibrillation
has, however, been associated with an increased
risk of falls, and older patients starting warfarin for
atrial fibrillation have a high rate of hospitalization
for intracranial bleeding. Many practitioners are
reluctant, therefore, to prescribe an oral anticoagulant
for elderly patients who are at high risk for falls.
Which Oral Anticoagulant for Atrial Fibrillation?
The Medical Letter on Drugs and Therapeutics • April 11, 2016; (Issue 1492)
Direct-to-consumer advertisements continue to
urge patients who take warfarin (Coumadin, and
others) for atrial fibrillation to ask their doctors
about the benefits of one or another of the newer
oral...
Direct-to-consumer advertisements continue to
urge patients who take warfarin (Coumadin, and
others) for atrial fibrillation to ask their doctors
about the benefits of one or another of the newer
oral anticoagulants.
Drugs for Hypothyroidism
The Medical Letter on Drugs and Therapeutics • October 26, 2015; (Issue 1480)
Primary hypothyroidism is usually the result of
Hashimoto's thyroiditis, thyroidectomy, or radioactive
iodine therapy. Treatment of hypothyroidism with
replacement doses of thyroid hormone is...
Primary hypothyroidism is usually the result of
Hashimoto's thyroiditis, thyroidectomy, or radioactive
iodine therapy. Treatment of hypothyroidism with
replacement doses of thyroid hormone is usually
lifelong. Levothyroxine is the drug of choice.
Edoxaban (Savaysa) - The Fourth New Oral Anticoagulant
The Medical Letter on Drugs and Therapeutics • March 30, 2015; (Issue 1465)
The FDA has approved edoxaban (Savaysa – Daiichi
Sankyo), a once-daily, oral, direct factor Xa inhibitor,
for treatment of venous thromoboembolism (VTE)
and for prevention of stroke and systemic...
The FDA has approved edoxaban (Savaysa – Daiichi
Sankyo), a once-daily, oral, direct factor Xa inhibitor,
for treatment of venous thromoboembolism (VTE)
and for prevention of stroke and systemic embolism
in patients with nonvalvular atrial fibrillation. It is the
fourth new oral anticoagulant to be approved for VTE
and nonvalvular atrial fibrillation.
Oritavancin (Orbactiv) for Skin and Skin Structure Infections
The Medical Letter on Drugs and Therapeutics • January 5, 2015; (Issue 1459)
The FDA has approved oritavancin (Orbactiv – The
Medicines Company), a long-acting lipoglycopeptide
antibiotic given as a single intravenous (IV) dose, for
treatment of acute bacterial skin and skin...
The FDA has approved oritavancin (Orbactiv – The
Medicines Company), a long-acting lipoglycopeptide
antibiotic given as a single intravenous (IV) dose, for
treatment of acute bacterial skin and skin structure
infections caused by susceptible gram-positive
bacteria in adults. It is the third lipoglycopeptide
antibiotic to be marketed in the US; telavancin (Vibativ)
and dalbavancin (Dalvance) were approved earlier.
Antithrombotic Drugs
The Medical Letter on Drugs and Therapeutics • October 27, 2014; (Issue 1454)
Antiplatelet drugs are the drugs of choice for
prevention and treatment of arterial thrombosis.
Anticoagulants are the drugs of choice for prevention
and treatment of venous thromboembolism and...
Antiplatelet drugs are the drugs of choice for
prevention and treatment of arterial thrombosis.
Anticoagulants are the drugs of choice for prevention
and treatment of venous thromboembolism and for
prevention of cardioembolic events in patients with
atrial fibrillation.
Drugs for Osteoarthritis
The Medical Letter on Drugs and Therapeutics • September 1, 2014; (Issue 1450)
Many different drugs are used for treatment of osteoarthritis
pain, but none of them prevent progression
of the disease. Many nonpharmacologic approaches
are available as well, including weight...
Many different drugs are used for treatment of osteoarthritis
pain, but none of them prevent progression
of the disease. Many nonpharmacologic approaches
are available as well, including weight management,
exercise, physical therapy, assistive devices, and total
joint arthroplasty. New guidelines for the management
of osteoarthritis have recently been published.
Drugs for Inflammatory Bowel Disease
The Medical Letter on Drugs and Therapeutics • August 4, 2014; (Issue 1448)
Aminosalicylates are effective for induction and maintenance
of remission in mild to moderate ulcerative
colitis. They are not recommended for treatment of
Crohn's disease.
FORMULATIONS — Oral mesalamine...
Aminosalicylates are effective for induction and maintenance
of remission in mild to moderate ulcerative
colitis. They are not recommended for treatment of
Crohn's disease.
FORMULATIONS — Oral mesalamine is rapidly absorbed in the small intestine and most of the drug does not reach the colon. Pentasa releases mesalamine gradually throughout the gastrointestinal tract. Delzicol, Asacol HD, Lialda, and Apriso delay the release of the drug until it reaches the distal ileum and colon. Sulfasalazine (Azulfidine, and generics), balsalazide (Colazal, and others), and olsalazine (Dipentum) are prodrugs; mesalamine is azo-bonded to a second moiety and released in the colon following bacterial cleavage of the bond. Mesalamine is also available as an enema (Rowasa, and generics) and as a rectal suppository (Canasa).
FORMULATIONS — Oral mesalamine is rapidly absorbed in the small intestine and most of the drug does not reach the colon. Pentasa releases mesalamine gradually throughout the gastrointestinal tract. Delzicol, Asacol HD, Lialda, and Apriso delay the release of the drug until it reaches the distal ileum and colon. Sulfasalazine (Azulfidine, and generics), balsalazide (Colazal, and others), and olsalazine (Dipentum) are prodrugs; mesalamine is azo-bonded to a second moiety and released in the colon following bacterial cleavage of the bond. Mesalamine is also available as an enema (Rowasa, and generics) and as a rectal suppository (Canasa).
Treatment of Atrial Fibrillation
The Medical Letter on Drugs and Therapeutics • July 7, 2014; (Issue 1446)
The treatment of atrial fibrillation includes anticoagulation,
rate control, and rhythm control. New US
guidelines for the management of atrial fibrillation
have recently been...
The treatment of atrial fibrillation includes anticoagulation,
rate control, and rhythm control. New US
guidelines for the management of atrial fibrillation
have recently been published.
Riociguat (Adempas) for Pulmonary Hypertension
The Medical Letter on Drugs and Therapeutics • March 3, 2014; (Issue 1437)
The FDA has approved the sGC stimulator riociguat
(rye" oh sig' ue at; Adempas – Bayer) for oral treatment
of pulmonary arterial hypertension (PAH) and
chronic thromboembolic pulmonary...
The FDA has approved the sGC stimulator riociguat
(rye" oh sig' ue at; Adempas – Bayer) for oral treatment
of pulmonary arterial hypertension (PAH) and
chronic thromboembolic pulmonary hypertension
(CTEPH) following surgery or when surgery is not an
option. It is the first drug to be approved for treatment
of CTEPH.
Low-Dose Diclofenac (Zorvolex) for Pain
The Medical Letter on Drugs and Therapeutics • March 3, 2014; (Issue 1437)
The FDA has approved Zorvolex (Iroko), a low-dose
oral formulation of the relatively COX-2 selective NSAID
diclofenac, for treatment of mild-to-moderate acute pain
in...
The FDA has approved Zorvolex (Iroko), a low-dose
oral formulation of the relatively COX-2 selective NSAID
diclofenac, for treatment of mild-to-moderate acute pain
in adults.
Macitentan (Opsumit) for Pulmonary Arterial Hypertension
The Medical Letter on Drugs and Therapeutics • February 17, 2014; (Issue 1436)
The FDA has approved macitentan (ma" si ten' tan; Opsumit
– Actelion), for oral treatment of pulmonary arterial
hypertension (PAH). Macitentan is the second nonselective
endothelin receptor antagonist...
The FDA has approved macitentan (ma" si ten' tan; Opsumit
– Actelion), for oral treatment of pulmonary arterial
hypertension (PAH). Macitentan is the second nonselective
endothelin receptor antagonist approved for PAH. It is a derivative
of bosentan (Tracleer), which is also manufactured
by Actelion, and is scheduled to become available generically
in 2015. Riociguat (Adempas), another new drug for
this indication, will be reviewed in a future issue.
Volibris
New Oral Anticoagulants for Acute Venous Thromboembolism
The Medical Letter on Drugs and Therapeutics • January 6, 2014; (Issue 1433)
Anticoagulants are the drugs of choice for treatment
of deep vein thrombosis (DVT) and pulmonary
embolism (PE), collectively referred to as venous
thromboembolism...
Anticoagulants are the drugs of choice for treatment
of deep vein thrombosis (DVT) and pulmonary
embolism (PE), collectively referred to as venous
thromboembolism (VTE).
Rethinking Warfarin for Atrial Fibrillation
The Medical Letter on Drugs and Therapeutics • September 30, 2013; (Issue 1426)
Full-page newspaper advertisements and a series of television
commercials have urged patients with atrial fibrillation
to "rethink warfarin" in favor of Eliquis (apixaban –
Bristol-Myers Squibb). Apixaban...
Full-page newspaper advertisements and a series of television
commercials have urged patients with atrial fibrillation
to "rethink warfarin" in favor of Eliquis (apixaban –
Bristol-Myers Squibb). Apixaban is the latest of 3 new oral
anticoagulants now competing with warfarin (Coumadin,
and others) for the oral anticoagulant market.
Kcentra: A 4-Factor Prothrombin Complex Concentrate for Reversal of Warfarin Anticoagulation
The Medical Letter on Drugs and Therapeutics • July 8, 2013; (Issue 1420)
The FDA has approved use of Kcentra (CSL Behring), a
human-derived 4-factor prothrombin complex concentrate
(PCC), for urgent reversal of warfarin anticoagulation
in adults with acute major bleeding. It is...
The FDA has approved use of Kcentra (CSL Behring), a
human-derived 4-factor prothrombin complex concentrate
(PCC), for urgent reversal of warfarin anticoagulation
in adults with acute major bleeding. It is the only
4-factor PCC available in the US.
Apixaban (Eliquis) - A New Oral Anticoagulant for Atrial Fibrillation
The Medical Letter on Drugs and Therapeutics • February 4, 2013; (Issue 1409)
The FDA has approved apixaban (Eliquis – Bristol-Myers Squibb/Pfizer), an oral direct factor Xa inhibitor,
for prevention of stroke and systemic embolism in
patients with nonvalvular atrial fibrillation. It...
The FDA has approved apixaban (Eliquis – Bristol-Myers Squibb/Pfizer), an oral direct factor Xa inhibitor,
for prevention of stroke and systemic embolism in
patients with nonvalvular atrial fibrillation. It is the third
new oral anticoagulant to be approved for this indication
as an alternative to warfarin.
Choice of an Oral Anticoagulant in Atrial Fibrillation
The Medical Letter on Drugs and Therapeutics • October 1, 2012; (Issue 1400)
Atrial fibrillation increases the risk of thromboembolic
stroke. Anticoagulant therapy can reduce this risk and
is recommended for patients with atrial fibrillation and
one or more of the following:...
Atrial fibrillation increases the risk of thromboembolic
stroke. Anticoagulant therapy can reduce this risk and
is recommended for patients with atrial fibrillation and
one or more of the following: congestive heart failure,
hypertension, age ≥75 years, diabetes, or prior stroke
or transient ischemic attack (CHADS2 score ≥1).
Tablet Splitting
The Medical Letter on Drugs and Therapeutics • August 6, 2012; (Issue 1396)
Breaking drug tablets in half is a common practice. Since our last article on this subject, some new data
have become...
Breaking drug tablets in half is a common practice. Since our last article on this subject, some new data
have become available.
Drugs for Rheumatoid Arthritis
The Medical Letter on Drugs and Therapeutics • May 1, 2012; (Issue 117)
Disease-modifying anti-rheumatic drugs (DMARDs)
are now used early in the treatment of rheumatoid
arthritis (RA) to achieve clinical remission, prevent
irreversible damage to joints, and minimize...
Disease-modifying anti-rheumatic drugs (DMARDs)
are now used early in the treatment of rheumatoid
arthritis (RA) to achieve clinical remission, prevent
irreversible damage to joints, and minimize toxicity
associated with nonsteroidal anti-inflammatory drugs
(NSAIDs) and corticosteroids. DMARDs (Table 1)
generally do not have an immediate analgesic effect,
but over time can control symptoms and have been
shown to delay and possibly stop progression of the
disease. NSAIDs have immediate analgesic and antiinflammatory
effects, but may not affect the disease
process. Oral corticosteroids can relieve joint symptoms
and control systemic manifestations, but their
chronic use can cause many complications. Judicious
use of intra-articular corticosteroids can rapidly
decrease inflammation in acute joints with few, if any,
adverse effects.
Bleeding with Dabigatran (Pradaxa)
The Medical Letter on Drugs and Therapeutics • December 12, 2011; (Issue 1379)
The labeling of dabigatran etexilate (Pradaxa –
Boehringer Ingelheim), an oral direct thrombin inhibitor,
has recently been updated to include new dosing and
monitoring recommendations and a warning on the...
The labeling of dabigatran etexilate (Pradaxa –
Boehringer Ingelheim), an oral direct thrombin inhibitor,
has recently been updated to include new dosing and
monitoring recommendations and a warning on the risk
of bleeding. Dabigatran etexilate was approved in the
US in 2010 for the prevention of thromboembolic stroke
in patients with non-valvular atrial fibrillation. It has been
shown to be more effective than warfarin (Coumadin,
and others) for this indication.
Prothrombin Complex Concentrates to Reverse Warfarin-Related Bleeding
The Medical Letter on Drugs and Therapeutics • October 3, 2011; (Issue 1374)
Warfarin-related bleeding, especially intracranial hemorrhage,
can be catastrophic. Several products are available
to reverse warfarin’s anticoagulant...
Warfarin-related bleeding, especially intracranial hemorrhage,
can be catastrophic. Several products are available
to reverse warfarin’s anticoagulant effect.
Antithrombotic Drugs
The Medical Letter on Drugs and Therapeutics • October 1, 2011; (Issue 110)
Arterial thrombi are composed mainly of platelet
aggregates held together by small amounts of fibrin.
Antiplatelet drugs are the drugs of choice for prevention
and treatment of arterial thrombosis, but...
Arterial thrombi are composed mainly of platelet
aggregates held together by small amounts of fibrin.
Antiplatelet drugs are the drugs of choice for prevention
and treatment of arterial thrombosis, but anticoagulants
are also effective, and their effects can add to those of
antiplatelet drugs. Venous thrombi are composed
mainly of fibrin and trapped red blood cells, with relatively
few platelets. Anticoagulants are the agents of
choice for prevention and treatment of venous thromboembolism
and for prevention of cardioembolic
events in patients with atrial fibrillation.
Rivaroxaban (Xarelto) - A New Oral Anticoagulant
The Medical Letter on Drugs and Therapeutics • August 22, 2011; (Issue 1371)
The FDA has approved rivaroxaban (Xarelto –
Janssen), an oral direct factor Xa inhibitor, for prevention
of deep vein thrombosis (DVT) in patients undergoing
knee or hip replacement...
The FDA has approved rivaroxaban (Xarelto –
Janssen), an oral direct factor Xa inhibitor, for prevention
of deep vein thrombosis (DVT) in patients undergoing
knee or hip replacement surgery.
Drugs for Treatment of ADHD
The Medical Letter on Drugs and Therapeutics • May 1, 2011; (Issue 105)
Attention-deficit/hyperactivity disorder (ADHD) is a disruptive behavior disorder that occurs in about 5%
of school-age children, most often in boys, and frequently persists into young...
Attention-deficit/hyperactivity disorder (ADHD) is a disruptive behavior disorder that occurs in about 5%
of school-age children, most often in boys, and frequently persists into young adulthood.
Dabigatran Etexilate (Pradaxa) - A New Oral Anticoagulant
The Medical Letter on Drugs and Therapeutics • November 15, 2010; (Issue 1351)
The FDA has approved the oral direct thrombin
inhibitor dabigatran (da big’ a tran) etexilate (Pradaxa –
Boehringer Ingelheim) for prevention of thromboembolic
stroke in patients with non-valvular atrial...
The FDA has approved the oral direct thrombin
inhibitor dabigatran (da big’ a tran) etexilate (Pradaxa –
Boehringer Ingelheim) for prevention of thromboembolic
stroke in patients with non-valvular atrial fibrillation.
It has been available in Canada (Pradax) since
2008 for prevention of thromboembolism in patients
undergoing knee or hip replacement surgery and was
recently approved there for use in atrial fibrillation.
Desirudin (Iprivask) for DVT Prevention
The Medical Letter on Drugs and Therapeutics • November 1, 2010; (Issue 1350)
The injectable direct thrombin inhibitor desirudin (Iprivask – Canyon), a recombinant analog of hirudin,
the leech anticoagulant protein, was approved by the FDA in 2003 for prevention of venous...
The injectable direct thrombin inhibitor desirudin (Iprivask – Canyon), a recombinant analog of hirudin,
the leech anticoagulant protein, was approved by the FDA in 2003 for prevention of venous thromboembolism (VTE) after elective hip arthroplasty, but was only marketed recently in the US. It has been available in Europe as Revasc for about 10 years. Two other hirudin analogs are available in the US: lepirudin (Refludan) for treatment of heparin-induced thrombocytopenia (HIT) and bivalirudin (Angiomax) for use in percutaneous coronary intervention (PCI).
Treatment of Atrial Fibrillation
The Medical Letter on Drugs and Therapeutics • September 1, 2010; (Issue 97)
The treatment of atrial fibrillation includes ventricular rate control, anticoagulation, conversion to normal sinus rhythm and maintenance of sinus rhythm. The choice of therapies that can achieve these goals...
The treatment of atrial fibrillation includes ventricular rate control, anticoagulation, conversion to normal sinus rhythm and maintenance of sinus rhythm. The choice of therapies that can achieve these goals is discussed in the text that follows. Some drugs are recommended here for indications that have not been approved by the FDA.
Intravenous Ibuprofen (Caldolor)
The Medical Letter on Drugs and Therapeutics • January 11, 2010; (Issue 1329)
An intraveneous (IV) formulation of ibuprofen (Caldolor - Cumberland) was recently approved by the FDA for use in adults. It can be administered alone for treatment of mild to moderate pain or as an adjunct to...
An intraveneous (IV) formulation of ibuprofen (Caldolor - Cumberland) was recently approved by the FDA for use in adults. It can be administered alone for treatment of mild to moderate pain or as an adjunct to opioid analgesics for moderate to severe pain. It is also approved for reduction of fever.
Tadalafil (Adcirca) for Pulmonary Arterial Hypertension
The Medical Letter on Drugs and Therapeutics • November 2, 2009; (Issue 1324)
The FDA has approved use of tadalafil (Adcirca - Lilly/United Therapeutics) for treatment of pulmonary arterial hypertension...
The FDA has approved use of tadalafil (Adcirca - Lilly/United Therapeutics) for treatment of pulmonary arterial hypertension (PAH).
Tablet Splitting
The Medical Letter on Drugs and Therapeutics • August 10, 2009; (Issue 1318)
Readers have asked us to update our 2004 article on tablet splitting. Breaking drug tablets in half is a common practice, but the FDA recently advised consumers against it (FDA Consumer Health Information, July...
Readers have asked us to update our 2004 article on tablet splitting. Breaking drug tablets in half is a common practice, but the FDA recently advised consumers against it (FDA Consumer Health Information, July 2009).
Drugs for Thyroid Disorders
The Medical Letter on Drugs and Therapeutics • August 1, 2009; (Issue 84)
Primary hypothyroidism is usually the result of Hashimoto's thyroiditis, thyroidectomy for hyperthyroidism, goiter or cancer, or radioactive iodine therapy for...
Primary hypothyroidism is usually the result of Hashimoto's thyroiditis, thyroidectomy for hyperthyroidism, goiter or cancer, or radioactive iodine therapy for hyperthyroidism.
In Brief: Prevention of Stroke in Patients with Atrial Fibrillation
The Medical Letter on Drugs and Therapeutics • June 1, 2009; (Issue 1313)
Atrial fibrillation increases the risk of stroke by a factor of 5. A randomized controlled trial (ACTIVE W) in 6706 patients with atrial fibrillation and one or more additional risk factors (≥75 years old;...
Atrial fibrillation increases the risk of stroke by a factor of 5. A randomized controlled trial (ACTIVE W) in 6706 patients with atrial fibrillation and one or more additional risk factors (≥75 years old; hypertension; previous stroke, transient ischemic attack or non- CNS embolus; left ventricular ejection fraction <45%; peripheral vascular disease; or 55-74 years old plus diabetes or coronary artery disease) found that a vitamin K antagonist such as warfarin (Coumadin, and others) was superior to clopidogrel (Plavix) plus aspirin in preventing vascular events, especially ischemic stroke.1
Now another study (ACTIVE A) from the same group of investigators has compared addition of clopidogrel to aspirin with aspirin alone in 7554 patients with atrial fibrillation and one or more additional risk factors for stroke. All of these patients were considered “unsuitable” for treatment with a vitamin K antagonist. Vascular events, primarily stroke, occurred significantly more often with aspirin alone. Major bleeding occurred significantly more often with aspirin plus clopidogrel.2
Oral anticoagulation with a vitamin K antagonist such as warfarin continues to be the treatment of choice for patients with atrial fibrillation and one or more additional risk factors for stroke.3-5 In patients who cannot or will not take a vitamin K antagonist, clopidogrel plus aspirin appears to be more effective in preventing stroke than aspirin alone.
1. ACTIVE Writing Group of the ACTIVE Investigators. Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events (ACTIVE W): a randomised controlled trial. Lancet 2006; 367:1903.
2. ACTIVE Investigators. Effect of clopidogrel added to aspirin in patients with atrial fibrillation. N Engl J Med 2009; 360:2066.
3. Antiplatelet and anticoagulant drugs. Treat Guidel Med Lett 2008; 6:29.
4. DE Singer et al. Antithrombotic therapy in atrial fibrillation: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133 (6 suppl): 546S.
5. AS Go. The ACTIVE pursuit of stroke prevention in patients with atrial fibrillation. N Engl J Med 2009; 360:2127.
Download: U.S. English
Now another study (ACTIVE A) from the same group of investigators has compared addition of clopidogrel to aspirin with aspirin alone in 7554 patients with atrial fibrillation and one or more additional risk factors for stroke. All of these patients were considered “unsuitable” for treatment with a vitamin K antagonist. Vascular events, primarily stroke, occurred significantly more often with aspirin alone. Major bleeding occurred significantly more often with aspirin plus clopidogrel.2
Oral anticoagulation with a vitamin K antagonist such as warfarin continues to be the treatment of choice for patients with atrial fibrillation and one or more additional risk factors for stroke.3-5 In patients who cannot or will not take a vitamin K antagonist, clopidogrel plus aspirin appears to be more effective in preventing stroke than aspirin alone.
1. ACTIVE Writing Group of the ACTIVE Investigators. Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events (ACTIVE W): a randomised controlled trial. Lancet 2006; 367:1903.
2. ACTIVE Investigators. Effect of clopidogrel added to aspirin in patients with atrial fibrillation. N Engl J Med 2009; 360:2066.
3. Antiplatelet and anticoagulant drugs. Treat Guidel Med Lett 2008; 6:29.
4. DE Singer et al. Antithrombotic therapy in atrial fibrillation: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133 (6 suppl): 546S.
5. AS Go. The ACTIVE pursuit of stroke prevention in patients with atrial fibrillation. N Engl J Med 2009; 360:2127.
Download: U.S. English
Fenofibric Acid (Trilipix)
The Medical Letter on Drugs and Therapeutics • May 4, 2009; (Issue 1311)
The FDA has approved the marketing of fenofibric acid (Trilipix - Abbott) to reduce triglycerides and increase HDL-C in patients with mixed dyslipidemia on optimal doses of a HMG-CoA reductase inhibitor...
The FDA has approved the marketing of fenofibric acid (Trilipix - Abbott) to reduce triglycerides and increase HDL-C in patients with mixed dyslipidemia on optimal doses of a HMG-CoA reductase inhibitor (statin) who have, or have risk factors for, coronary heart disease. It is the first fibrate approved by the FDA specifically for combined use with a statin. Trilipix is also approved as monotherapy for hypertriglyceridemia, hypercholesterolemia and low HDL-C. The patent for Tricor, Abbott's older formulation of fenofibrate, will expire in 2011.
Drugs for Rheumatoid Arthritis
The Medical Letter on Drugs and Therapeutics • May 1, 2009; (Issue 81)
Disease-modifying anti-rheumatic drugs (DMARDs) are now used early in the treatment of rheumatoid arthritis (RA) to prevent irreversible damage to joints and minimize toxicities associated with nonsteroidal...
Disease-modifying anti-rheumatic drugs (DMARDs) are now used early in the treatment of rheumatoid arthritis (RA) to prevent irreversible damage to joints and minimize toxicities associated with nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids.
Dexlansoprazole (Kapidex) for GERD and Erosive Esophagitis
The Medical Letter on Drugs and Therapeutics • March 23, 2009; (Issue 1308)
The FDA has approved the proton-pump inhibitor (PPI) dexlansoprazole (Kapidex - Takeda), a delayed release formulation of the R-enantiomer of lansoprazole (Prevacid - Takeda), for treating and maintaining...
The FDA has approved the proton-pump inhibitor (PPI) dexlansoprazole (Kapidex - Takeda), a delayed release formulation of the R-enantiomer of lansoprazole (Prevacid - Takeda), for treating and maintaining healing of erosive esophagitis and for treatment of heartburn associated with non-erosive gastroesophageal reflux disease (GERD).
Prevention of Venous Thromboembolism in Orthopedic Surgery
The Medical Letter on Drugs and Therapeutics • November 3, 2008; (Issue 1298)
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...
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.
Treatment of Peptic Ulcers and GERD
The Medical Letter on Drugs and Therapeutics • August 1, 2008; (Issue 72)
Peptic ulcers caused by treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) are mainly gastric ulcers. Most duodenal and other gastric ulcers are caused by the gram-negative bacillus Helicobacter...
Peptic ulcers caused by treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) are mainly gastric ulcers. Most duodenal and other gastric ulcers are caused by the gram-negative bacillus Helicobacter pylori. Gastroesophageal reflux disease (GERD) is caused by gastric acid reflux into the esophagus. Drugs that suppress gastric acid production are the primary treatment for GERD and peptic ulcers.
Addendum: Warfarin-Acetaminophen Interaction
The Medical Letter on Drugs and Therapeutics • June 16, 2008; (Issue 1288)
A reader expressed disappointment that our recent listing of “Some Warfarin Drug Interactions”1 did not include acetaminophen. Perhaps it should have. Acetaminophen can increase the anticoagulant effect of...
A reader expressed disappointment that our recent listing of “Some Warfarin Drug Interactions”1 did not include acetaminophen. Perhaps it should have. Acetaminophen can increase the anticoagulant effect of warfarin, particularly with continued use, but it does so inconsistently. The mechanism of this interaction has not been established, but may be related to an acetaminophen metabolite inhibiting vitamin K-epoxide reductase, the target for warfarin’s anticoagulant effect.2
Patient susceptibility varies, possibly on a genetic basis; occasional use of acetaminophen generally has little or no effect on the international normalized ratio (INR) in patients on chronic warfarin therapy, but in some, even a few grams of the drug may cause a dramatic increase in INR. One study in healthy subjects found no effect of acetaminophen 4 g per day for 2 weeks, while another study in patients with the same acetaminophen dose for the same period of time found a moderate increase in INR.3,4 It might be prudent to monitor INR in patients on chronic warfarin therapy more closely than usual when they take more than 2 g per day of acetaminophen for more than a few days.
1. Pharmacogenetic-based dosing of warfarin. Med Lett Drugs Ther 2008; 50:39.
2. HH Thijssen et al. Paracetamol (acetaminophen) warfarin interaction: NAPQI, the toxic metabolite of paracetamol, is an inhibitor of enzymes in the vitamin K cycle. Thromb Haemost 2004; 92:797.
3. D Kwan et al. The effects of acetaminophen on pharmacokinetics and pharmacodynamics of warfarin. J Clin Pharmacol 1999; 39:68.
4. I Mahe et al. Paracetamol: A haemorrhagic risk factor in patients on warfarin. Br J Clin Pharmacol 2005; 59:371.
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Patient susceptibility varies, possibly on a genetic basis; occasional use of acetaminophen generally has little or no effect on the international normalized ratio (INR) in patients on chronic warfarin therapy, but in some, even a few grams of the drug may cause a dramatic increase in INR. One study in healthy subjects found no effect of acetaminophen 4 g per day for 2 weeks, while another study in patients with the same acetaminophen dose for the same period of time found a moderate increase in INR.3,4 It might be prudent to monitor INR in patients on chronic warfarin therapy more closely than usual when they take more than 2 g per day of acetaminophen for more than a few days.
1. Pharmacogenetic-based dosing of warfarin. Med Lett Drugs Ther 2008; 50:39.
2. HH Thijssen et al. Paracetamol (acetaminophen) warfarin interaction: NAPQI, the toxic metabolite of paracetamol, is an inhibitor of enzymes in the vitamin K cycle. Thromb Haemost 2004; 92:797.
3. D Kwan et al. The effects of acetaminophen on pharmacokinetics and pharmacodynamics of warfarin. J Clin Pharmacol 1999; 39:68.
4. I Mahe et al. Paracetamol: A haemorrhagic risk factor in patients on warfarin. Br J Clin Pharmacol 2005; 59:371.
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Pharmacogenetic-Based Dosing of Warfarin
The Medical Letter on Drugs and Therapeutics • May 19, 2008; (Issue 1286)
Warfarin sodium (Coumadin, and others) and other coumarin anticoagulants prevent thrombosis, but patient response is highly variable and overanticoagulation can lead to hemorrhage. Genotyping patients for...
Warfarin sodium (Coumadin, and others) and other coumarin anticoagulants prevent thrombosis, but patient response is highly variable and overanticoagulation can lead to hemorrhage. Genotyping patients for single nucleotide polymorphisms (SNPs) that affect coumarin metabolism and sensitivity may help clinicians estimate the therapeutic warfarin dose. The FDA has added a note to warfarin labeling recommending lowrange doses for patients with such genetic variations. Commercial tests for these variants are now available and cost about $500 per test.
Diclofenac Gel For Osteoarthritis
The Medical Letter on Drugs and Therapeutics • April 21, 2008; (Issue 1284)
The nonsteroidal anti-inflammatory drug (NSAID) diclofenac, has been approved by the FDA in a 1% topical gel formulation (Voltaren Gel - Endo) for treatment of osteoarthritis (OA). A 3% topical diclofenac gel...
The nonsteroidal anti-inflammatory drug (NSAID) diclofenac, has been approved by the FDA in a 1% topical gel formulation (Voltaren Gel - Endo) for treatment of osteoarthritis (OA). A 3% topical diclofenac gel (Solaraze) is currently approved for treatment of actinic keratoses, but not for topical use on joints. No other topical NSAIDs are approved by the FDA for OA. A diclofenac patch (Flector) was recently approved by the FDA for treatment of pain due to minor strains, sprains and contusions.
In Brief: Herbal Warning
The Medical Letter on Drugs and Therapeutics • February 11, 2008; (Issue 1279)
The FDA recently advised health care professionals and consumers not to use a number of dietary supplements found to contain the phosphodiesterase-5 inhibitor sildenafil (Viagra) or an analog of the drug...
The FDA recently advised health care professionals and consumers not to use a number of dietary supplements found to contain the phosphodiesterase-5 inhibitor sildenafil (Viagra) or an analog of the drug (www.fda.gov). Although the effects of sildenafil may be noticeable (in men), the presence of other, possibly more toxic adulterants in dietary supplements may be more difficult or impossible to detect.
Other drugs previously found in dietary supplements have included lovastatin (Mevacor, and others), estrogen, alprazolam (Xanax, and others), indomethacin (Indocin, and others) and warfarin (Coumadin, and others). Aristolochic acid in Chinese herbal weight loss products caused acute renal failure in about 100 women in Belgium; at least 70 of them required dialysis or transplantation, and at least 18 developed urothelial cancer (Med Lett Drugs Ther 2002; 44:84).
Dietary supplements do not require FDA approval before marketing. The agency does have the power to remove mislabeled or adulterated products from store shelves, but the burden of discovery and proof is entirely on the government.
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Other drugs previously found in dietary supplements have included lovastatin (Mevacor, and others), estrogen, alprazolam (Xanax, and others), indomethacin (Indocin, and others) and warfarin (Coumadin, and others). Aristolochic acid in Chinese herbal weight loss products caused acute renal failure in about 100 women in Belgium; at least 70 of them required dialysis or transplantation, and at least 18 developed urothelial cancer (Med Lett Drugs Ther 2002; 44:84).
Dietary supplements do not require FDA approval before marketing. The agency does have the power to remove mislabeled or adulterated products from store shelves, but the burden of discovery and proof is entirely on the government.
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Antifungal Drugs
The Medical Letter on Drugs and Therapeutics • January 1, 2008; (Issue 65)
The drugs of choice for treatment of some fungal infections are listed in the tables. Some of the indications and dosages recommended here have not been approved by the FDA. Other guidelines are available from...
The drugs of choice for treatment of some fungal infections are listed in the tables. Some of the indications and dosages recommended here have not been approved by the FDA. Other guidelines are available from the Infectious Diseases Society of America (www.idsociety.org).
Ambrisentan (Letairis) for Pulmonary Arterial Hypertension
The Medical Letter on Drugs and Therapeutics • October 22, 2007; (Issue 1272)
Ambrisentan (Letairis - Gilead), a selective endothelin type A (ETA) receptor antagonist, has been approved by the FDA for treatment of symptomatic patients (WHO class II or III) with pulmonary arterial...
Ambrisentan (Letairis - Gilead), a selective endothelin type A (ETA) receptor antagonist, has been approved by the FDA for treatment of symptomatic patients (WHO class II or III) with pulmonary arterial hypertension (PAH).
Coenzyme Q10
The Medical Letter on Drugs and Therapeutics • February 27, 2006; (Issue 1229)
Coenzyme Q10, a fat-soluble antioxidant also known as ubidecarenone, ubiquinone and CoQ10, is marketed as a dietary supplement in the US, both as a single ingredient and in various combination...
Coenzyme Q10, a fat-soluble antioxidant also known as ubidecarenone, ubiquinone and CoQ10, is marketed as a dietary supplement in the US, both as a single ingredient and in various combination products.
Drugs for Rheumatoid Arthritis
The Medical Letter on Drugs and Therapeutics • December 1, 2005; (Issue 40)
To prevent irreversible damage to joints and minimize toxicities associated with nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids, disease modifying anti-rheumatic drugs (DMARDs) are now used...
To prevent irreversible damage to joints and minimize toxicities associated with nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids, disease modifying anti-rheumatic drugs (DMARDs) are now used early in the treatment of rheumatoid arthritis (RA). The DMARDs listed in the table on page 84 have no immediate analgesic effects, but can control symptoms and have been shown to delay and possibly stop progression of the disease. The NSAIDs listed in the table on page 88 have analgesic and anti-inflammatory effects, but may not affect the disease process. Oral corticosteroids can rapidly relieve joint symptoms and control systemic manifestations, but their chronic use is associated with many complications.
Azithromycin Extended-Release (Zmax) for Sinusitis and Pneumonia
The Medical Letter on Drugs and Therapeutics • September 28, 2005; (Issue 1218)
Zmax (Pfizer), an extended-release oral suspension of azithromycin, has been approved by the FDA for single dose treatment of mild to moderate community acquired pneumonia (CAP) and acute bacterial sinusitis...
Zmax (Pfizer), an extended-release oral suspension of azithromycin, has been approved by the FDA for single dose treatment of mild to moderate community acquired pneumonia (CAP) and acute bacterial sinusitis (ABS) in adults. Immediate-release azithromycin will probably become available generically later this year when its patent expires.
Tigecycline (Tygacil)
The Medical Letter on Drugs and Therapeutics • September 12, 2005; (Issue 1217)
Tigecycline (Tygacil - Wyeth), a derivative of minocycline, is a new intravenous (IV) antibiotic approved for treatment of complicated intra-abdominal and skin and skin-structure...
Tigecycline (Tygacil - Wyeth), a derivative of minocycline, is a new intravenous (IV) antibiotic approved for treatment of complicated intra-abdominal and skin and skin-structure infections.
Sildenafil (Revatio) for Pulmonary Arterial Hypertension
The Medical Letter on Drugs and Therapeutics • August 15, 2005; (Issue 1215)
The Medical Letter reported last year that sildenafil (Viagra - Pfizer) appeared to be effective for idiopathic pulmonary arterial hypertension (PAH), but confirmation from a controlled trial was needed. Now...
The Medical Letter reported last year that sildenafil (Viagra - Pfizer) appeared to be effective for idiopathic pulmonary arterial hypertension (PAH), but confirmation from a controlled trial was needed. Now the results of such a study are about to be published, and the drug has been approved by the FDA for this indication under the trade name Revatio.
Erlotinib (Tarceva) for Advanced Non-Small Cell Lung Cancer
The Medical Letter on Drugs and Therapeutics • March 28, 2005; (Issue 1205)
Erlotinib (Tarceva) is the second oral epidermal growth factor receptor (EGFR) inhibitor to become available in the US for treatment of advanced refractory NSCLC. In clinical trials, erlotinib produced a...
Erlotinib (Tarceva) is the second oral epidermal growth factor receptor (EGFR) inhibitor to become available in the US for treatment of advanced refractory NSCLC. In clinical trials, erlotinib produced a response rate of only 8.9%, but increased median survival from 4.7 to 6.7 months. Patients who had never smoked and those with EGFR-positive tumors survived longer. Erlotinib is generally well tolerated; diarrhea and rash are the most common adverse effects.
Extended-Release Carbamazepine (Equetro) for Bipolar Disorder
The Medical Letter on Drugs and Therapeutics • March 28, 2005; (Issue 1205)
An extended-release formulation of carbamazepine, available since 1997 for treatment of epilepsy, has now been approved under a new name, Equetro, for acute mania and mixed episodes of bipolar disorder....
An extended-release formulation of carbamazepine, available since 1997 for treatment of epilepsy, has now been approved under a new name, Equetro, for acute mania and mixed episodes of bipolar disorder. Although the drug was effective in some patients for up to 6 months, it has not been approved for maintenance treatment. Carbamazepine has not been shown to be more effective than lithium or valproate, and it can cause serious adverse effects.
Antifungal Drugs
The Medical Letter on Drugs and Therapeutics • February 1, 2005; (Issue 30)
The drugs of choice for treatment of some fungal infections are listed in the table that begins on page 8. Some of the indications and dosages recommended here have not been approved by the...
The drugs of choice for treatment of some fungal infections are listed in the table that begins on page 8. Some of the indications and dosages recommended here have not been approved by the FDA.
Drugs for Breast Cancer
The Medical Letter on Drugs and Therapeutics • January 1, 2005; (Issue 29)
In addition to surgery and radiation therapy, a variety of drugs are used both singly and in combination to treat breast cancer. This article summarizes the principles of adjuvant therapy and treatment for...
In addition to surgery and radiation therapy, a variety of drugs are used both singly and in combination to treat breast cancer. This article summarizes the principles of adjuvant therapy and treatment for metastatic disease. A summary of individual drugs and their adverse effects begins on page 3.
Drugs for Tuberculosis
The Medical Letter on Drugs and Therapeutics • December 1, 2004; (Issue 28)
Tuberculosis (TB) is still a problem in the United States, even though the incidence continues to decline in most of the country (MMWR Morbid Mortal Wkly Rep 2004; 53:209). Treatment of TB can be divided into...
Tuberculosis (TB) is still a problem in the United States, even though the incidence continues to decline in most of the country (MMWR Morbid Mortal Wkly Rep 2004; 53:209). Treatment of TB can be divided into treatment of latent infection diagnosed by a positive PPD and treatment of active clinical TB. Guidelines with detailed management recommendations are available from the US Centers for Disease Control and Prevention (CDC) (MMWR Morbid Mortal Wkly Rep 2003; 52RR-11:1).
Tablet Splitting
The Medical Letter on Drugs and Therapeutics • November 8, 2004; (Issue 1195)
Breaking drug tablets in half is a common practice. In some cases, a lower drug dose may be as effective as a higher one, with fewer adverse effects. Sometimes tablets are split to achieve an intermediate dose...
Breaking drug tablets in half is a common practice. In some cases, a lower drug dose may be as effective as a higher one, with fewer adverse effects. Sometimes tablets are split to achieve an intermediate dose between marketed strengths. When 2 tablet sizes cost the same, as they often do, splitting the larger size saves money. Is this a reasonable practice?
Tinidazole (Tindamax) - A New Anti-Protozoal Drug
The Medical Letter on Drugs and Therapeutics • August 30, 2004; (Issue 1190)
Tinidazole (Tindamax - Presutti Labs), an oral antiprotozoal drug similar to metronidazole (Flagyl, and others), has been approved by the FDA for treatment of trichomoniasis in adults and for treatment of...
Tinidazole (Tindamax - Presutti Labs), an oral antiprotozoal drug similar to metronidazole (Flagyl, and others), has been approved by the FDA for treatment of trichomoniasis in adults and for treatment of giardiasis, intestinal amebiasis and amebic liver abcess in adults and children more than 3 years old. Tinidazole has been widely used outside of the US for decades under the trade name Fasigyn (Pfizer).
New Indications for Modafinil (Provigil)
The Medical Letter on Drugs and Therapeutics • April 26, 2004; (Issue 1181)
Modafinil (Provigil - Cephalon; Alertec - Draxis in Canada), first approved by the FDA in 1999 for treatment of excessive daytime sleepiness associated with narcolepsy (Medical Letter 1999; 41:30), has now also...
Modafinil (Provigil - Cephalon; Alertec - Draxis in Canada), first approved by the FDA in 1999 for treatment of excessive daytime sleepiness associated with narcolepsy (Medical Letter 1999; 41:30), has now also been approved for treatment of patients with excessive sleepiness due to obstructive sleep apnea/hypopnea syndrome (OSAHS) or shift work sleep disorder (SWSD) (DSM-IV, text revision, Washington, DC: American Psychiatric Association, 2000, page 622).
Sildenafil for Pulmonary Hypertension
The Medical Letter on Drugs and Therapeutics • March 1, 2004; (Issue 1177)
Several recent case reports suggest that oral sildenafil may be effective for treatment of pulmonary arterial hypertension (PAH). Sildenafil is currently marketed as Viagra for treatment of erectile dysfunction...
Several recent case reports suggest that oral sildenafil may be effective for treatment of pulmonary arterial hypertension (PAH). Sildenafil is currently marketed as Viagra for treatment of erectile dysfunction (Medical Letter 1998; 40:51).
Drugs for Peptic Ulcers
The Medical Letter on Drugs and Therapeutics • February 1, 2004; (Issue 18)
Most peptic ulcers not caused by nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with infection of the gastric mucosa by the gram-negative bacilli Helicobacter pylori. The majority of NSAID-related...
Most peptic ulcers not caused by nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with infection of the gastric mucosa by the gram-negative bacilli Helicobacter pylori. The majority of NSAID-related ulcers are gastric. H. pylori infection causes both duodenal and gastric ulcers. Eradication of H. pylori promotes healing and markedly decreases recurrence of both duodenal and gastric ulcers (A Shiotamni and DY Graham, Med Clin North Am 2002; 86:1447; FKL Chan and WK Leung, Lancet 2002; 360:933). The first step in the management of peptic ulcers is the diagnosis and treatment of H. pylori.
Drug Interactions with Grapefruit Juice
The Medical Letter on Drugs and Therapeutics • January 5, 2004; (Issue 1173)
The ability of grapefruit juice to increase serum concentrations of drugs was first discovered during a study of the effect of ethanol on felodipine (Plendil) pharmacokinetics. Double-strength grapefruit juice...
The ability of grapefruit juice to increase serum concentrations of drugs was first discovered during a study of the effect of ethanol on felodipine (Plendil) pharmacokinetics. Double-strength grapefruit juice used to disguise the taste of ethanol resulted in higher than expected serum concentrations of felodipine (DG Bailey et al, Clin Invest Med 1989; 12:357).
Rosuvastatin - a New Lipid-lowering Drug
The Medical Letter on Drugs and Therapeutics • October 13, 2003; (Issue 1167)
Rosuvastatin (Crestor - AstraZeneca), an HMG-CoA reductase inhibitor (or "statin"), was recently approved by the FDA for lowering serum cholesterol and triglyceride concentrations and raising HDL cholesterol...
Rosuvastatin (Crestor - AstraZeneca), an HMG-CoA reductase inhibitor (or "statin"), was recently approved by the FDA for lowering serum cholesterol and triglyceride concentrations and raising HDL cholesterol levels. Rosuvastatin, like other statins, inhibits the enzyme that catalyzes the rate-limiting step in cholesterol synthesis, but it is claimed to be more potent than the others. All of these drugs must be taken indefinitely; if they are discontinued, lipid levels return to baseline.
Drug Interactions
The Medical Letter on Drugs and Therapeutics • June 8, 2003; (Issue 1158)
Changes caused by one drug in the absorption, distribution, metabolism or excretion of another may lead to a pharmacokinetic adverse drug interaction (DN Juurlink et al, JAMA 2003; 289:1652). Additive drug...
Changes caused by one drug in the absorption, distribution, metabolism or excretion of another may lead to a pharmacokinetic adverse drug interaction (DN Juurlink et al, JAMA 2003; 289:1652). Additive drug interactions, such as vasodilation caused by both sildenafil (Viagra) and nitrates, can also have adverse effects.
Drugs for Rheumatoid Arthritis
The Medical Letter on Drugs and Therapeutics • January 1, 2003; (Issue 5)
Many different drugs are now used to treat rheumatoid arthritis. Nonsteroidal anti-inflammatory drugs (NSAIDs), listed in the table on page 26, have analgesic and anti-inflammatory effects, but may not affect...
Many different drugs are now used to treat rheumatoid arthritis. Nonsteroidal anti-inflammatory drugs (NSAIDs), listed in the table on page 26, have analgesic and anti-inflammatory effects, but may not affect the disease process. Corticosteroids can provide rapid relief of joint symptoms and control of systemic manifestations, but chronic use is associated with many complications. The "disease-modifying" anti-rheumatic drugs (DMARDs), listed on page 29, have no immediate analgesic effects, but can control symptoms and may delay progression of the disease (American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines, Arthritis Rheum 2002; 46:328). Interactions of anti-rheumatic drugs with other drugs are listed in The Medical Letter Handbook of Adverse Drug Interactions, 2003.
Treprostinil (Remodulin) for Pulmonary Arterial Hypertension
The Medical Letter on Drugs and Therapeutics • September 16, 2002; (Issue 1139)
Treprostinil sodium (tre prost' in il; Remodulin - United Therapeutics), a prostacyclin analogue, has been approved by the FDA for continuous subcutaneous (SC) treatment of patients with pulmonary arterial...
Treprostinil sodium (tre prost' in il; Remodulin - United Therapeutics), a prostacyclin analogue, has been approved by the FDA for continuous subcutaneous (SC) treatment of patients with pulmonary arterial hypertension who have dyspnea on more than minimal exertion (NYHA Class II-IV).
Valdecoxib (Bextra) - a New Cyclooxygenase-2 Inhibitor
The Medical Letter on Drugs and Therapeutics • April 29, 2002; (Issue 1129)
Valdecoxib (Bextra - Pharmacia/Pfizer), a selective cyclooxygenase (COX-2) inhibitor similar to celecoxib (Celebrex) and rofecoxib (Vioxx), was recently approved by the FDA for treatment of osteoarthritis,...
Valdecoxib (Bextra - Pharmacia/Pfizer), a selective cyclooxygenase (COX-2) inhibitor similar to celecoxib (Celebrex) and rofecoxib (Vioxx), was recently approved by the FDA for treatment of osteoarthritis, rheumatoid arthritis and primary dysmenorrhea.
Bosentan (Tracleer) for Pulmonary Arterial Hypertension
The Medical Letter on Drugs and Therapeutics • April 1, 2002; (Issue 1127)
Bosentan (Tracleer - Actelion), a non-peptide endothelin receptor antagonist, has been approved by the FDA for oral treatment of patients who have pulmonary arterial hypertension (PAH) with symptoms of dyspnea...
Bosentan (Tracleer - Actelion), a non-peptide endothelin receptor antagonist, has been approved by the FDA for oral treatment of patients who have pulmonary arterial hypertension (PAH) with symptoms of dyspnea at rest or with minimal exertion.
Gleevec (STI-571) For Chronic Myeloid Leukemia
The Medical Letter on Drugs and Therapeutics • June 11, 2001; (Issue 1106)
Imatinib mesylate (STI-571; Gleevec - Novartis), an oral tyrosine kinase inhibitor, has received accelerated approval from the FDA for treatment of all phases of chronic myeloid leukemia (CML) after interferon...
Imatinib mesylate (STI-571; Gleevec - Novartis), an oral tyrosine kinase inhibitor, has received accelerated approval from the FDA for treatment of all phases of chronic myeloid leukemia (CML) after interferon has failed.
Colesevelam (Welchol) For Hypercholesterolemia
The Medical Letter on Drugs and Therapeutics • October 30, 2000; (Issue 1091)
Colesevelam hydrochloride (Welchol - Sankyo Pharma), a nonabsorbed hydrophilic polymer that binds bile acids, has been approved by the FDA for reduction of plasma LDL cholesterol in patients with primary...
Colesevelam hydrochloride (Welchol - Sankyo Pharma), a nonabsorbed hydrophilic polymer that binds bile acids, has been approved by the FDA for reduction of plasma LDL cholesterol in patients with primary hypercholesterolemia.
Rivastigmine (Exelon) For Alzheimer's Disease
The Medical Letter on Drugs and Therapeutics • October 2, 2000; (Issue 1089)
Rivastigmine tartrate (Exelon - Novartis), a carbamate-based cholinesterase inhibitor, is now being marketed for treatment of patients with dementia due to Alzheimer's...
Rivastigmine tartrate (Exelon - Novartis), a carbamate-based cholinesterase inhibitor, is now being marketed for treatment of patients with dementia due to Alzheimer's disease.
Drugs for Pain: A Clarification
The Medical Letter on Drugs and Therapeutics • September 18, 2000; (Issue 1087)
Selective COX-2 Inhibitors and Bleeding Risk: An Additional Note - The Medical Letter article on Drugs for Pain (August 21, 2000) stated that the selective COX-2 inhibitors celecoxib (Celebrex) and rofecoxib...
Selective COX-2 Inhibitors and Bleeding Risk: An Additional Note - The Medical Letter article on Drugs for Pain (August 21, 2000) stated that the selective COX-2 inhibitors celecoxib (Celebrex) and rofecoxib (Vioxx) do not inhibit platelet aggregation or bleeding time. Perhaps we should have added, as we did in discussing use of these drugs in rheumatoid arthritis (July 10, 2000), that both celecoxib and rofecoxib, if given with warfarin (Coumadin, and others), increase INR and prothrombin time values and may increase the risk of bleeding.
Pantroprazole (Protonix)
The Medical Letter on Drugs and Therapeutics • July 24, 2000; (Issue 1083)
Pantoprazole, the fourth benzimidazole proton pump inhibitor to become available in the United States, has been marketed for short-term oral treatment of erosive gastroesophageal reflux disease...
Pantoprazole, the fourth benzimidazole proton pump inhibitor to become available in the United States, has been marketed for short-term oral treatment of erosive gastroesophageal reflux disease (GERD).
Drugs For Rheumatoid Arthritis
The Medical Letter on Drugs and Therapeutics • July 10, 2000; (Issue 1082)
Many different drugs are now used to treat rheumatoid arthritis. Nonsteroidal anti-inflammatory drugs (NSAIDs) have analgesic and anti-inflammatory effects, but may not affect the disease process. The...
Many different drugs are now used to treat rheumatoid arthritis. Nonsteroidal anti-inflammatory drugs (NSAIDs) have analgesic and anti-inflammatory effects, but may not affect the disease process. The "disease-modifying anti-rheumatic"drugs (DMARDs) have no immediate analgesic effects, but can control symptoms and may delay progression of the disease.
Drug Interactions with St. John's Wort
The Medical Letter on Drugs and Therapeutics • June 26, 2000; (Issue 1081)
Even though its effectiveness has not been established, many patients take St. John's Wort (Hypericum perforatum), an over-the-counter herbal extract, to treat symptoms of depression, often without the...
Even though its effectiveness has not been established, many patients take St. John's Wort (Hypericum perforatum), an over-the-counter herbal extract, to treat symptoms of depression, often without the knowledge of their physicians. Recent reports indicate that St. John's wort interacts adversely with a number of drugs.
Meloxicam (Mobic) for Osteoarthritis
The Medical Letter on Drugs and Therapeutics • May 29, 2000; (Issue 1079)
Meloxicam, a nonsteroidal anti-inflammatory drug (NSAID) with some cyclooxygenase-2 (COX-2) selectivity in vitro, has been approved by the FDA for treatment of...
Meloxicam, a nonsteroidal anti-inflammatory drug (NSAID) with some cyclooxygenase-2 (COX-2) selectivity in vitro, has been approved by the FDA for treatment of osteoarthritis.
Dofetilide for Atrial Fibrillation
The Medical Letter on Drugs and Therapeutics • May 15, 2000; (Issue 1078)
Dofetilide (Tikosyn - Pfizer), a new methanesulfonamide antiarrhythmic drug, has recently been marketed for oral treatment of atrial fibrillation and...
Dofetilide (Tikosyn - Pfizer), a new methanesulfonamide antiarrhythmic drug, has recently been marketed for oral treatment of atrial fibrillation and flutter.
Aggrenox: A Combination of Antiplatelet Drugs for Stroke Prevention
The Medical Letter on Drugs and Therapeutics • February 7, 2000; (Issue 1071)
Aggrenox, a fixed-dose oral combination of aspirin and extended-release dipyridamole, is now being advertised for secondary prevention of a transient ischemic attack (TIA) or ischemic...
Aggrenox, a fixed-dose oral combination of aspirin and extended-release dipyridamole, is now being advertised for secondary prevention of a transient ischemic attack (TIA) or ischemic stroke.
Rabeprazole
The Medical Letter on Drugs and Therapeutics • November 19, 1999; (Issue 1066)
Rabeprazole, a benzimidazole proton pump inhibitor similar to omeprazole and lansoprazole, has been approved by the FDA for treatment of duodenal ulcers, healing and maintenance treatment of erosive or...
Rabeprazole, a benzimidazole proton pump inhibitor similar to omeprazole and lansoprazole, has been approved by the FDA for treatment of duodenal ulcers, healing and maintenance treatment of erosive or ulcerative gastroesophageal reflux disease, and for long-term treatment of chronic hypersecretory conditions, including Zollinger-Ellison syndrome
Amprenavir: A New HIV Protease Inhibitor
The Medical Letter on Drugs and Therapeutics • July 16, 1999; (Issue 1057)
Amprenavir is the fifth protease inhibitor to become available for treatment of HIV infection. It was approved by the FDA for use with other drugs in the treatment of HIV-infected adults and children at least...
Amprenavir is the fifth protease inhibitor to become available for treatment of HIV infection. It was approved by the FDA for use with other drugs in the treatment of HIV-infected adults and children at least four years old.
Rofecoxib for Osteoarthritis and Pain
The Medical Letter on Drugs and Therapeutics • July 2, 1999; (Issue 1056)
Rofecoxib, a selective COX-2 inhibitor, has been approved by the FDA for treatment of osteoarthritis, acute pain and menstrual...
Rofecoxib, a selective COX-2 inhibitor, has been approved by the FDA for treatment of osteoarthritis, acute pain and menstrual pain.
Drug Interactions
The Medical Letter on Drugs and Therapeutics • July 2, 1999; (Issue 1056)
Reports of adverse interactions between drugs continue to accumulate. Recently, the FDA has expanded the recommendations on drug interactions found in the package inserts of new...
Reports of adverse interactions between drugs continue to accumulate. Recently, the FDA has expanded the recommendations on drug interactions found in the package inserts of new drugs.
Generic drugs
The Medical Letter on Drugs and Therapeutics • May 21, 1999; (Issue 1053)
When patents expire on brand-name drugs, generic formulations become available that often cost much less. Some physicians, however, hesitate to prescribe the less expensive drug because of concerns about the...
When patents expire on brand-name drugs, generic formulations become available that often cost much less. Some physicians, however, hesitate to prescribe the less expensive drug because of concerns about the quality of generic formulations.
Modafinil for Narcolepsy
The Medical Letter on Drugs and Therapeutics • March 26, 1999; (Issue 1049)
Modafinil (Provigil), a benzhydryl sulfinylacetamide non-amphetamine stimulant that has been used in Europe since 1995, has now been approved by the FDA for treatment of excessive daytime sleepiness associated...
Modafinil (Provigil), a benzhydryl sulfinylacetamide non-amphetamine stimulant that has been used in Europe since 1995, has now been approved by the FDA for treatment of excessive daytime sleepiness associated with narcolepsy.
Citalopram for Depression
The Medical Letter on Drugs and Therapeutics • December 4, 1998; (Issue 1041)
Citalopram hydrobromide (Celexa - Forest/Parke-Davis), a selective serotonin reuptake inhibitor (SSRI) available in Europe since 1989, has now been approved by the US Food and Drug Administration (FDA) for...
Citalopram hydrobromide (Celexa - Forest/Parke-Davis), a selective serotonin reuptake inhibitor (SSRI) available in Europe since 1989, has now been approved by the US Food and Drug Administration (FDA) for treatment of depression. It is being advertised as having a 'favorable side-effect profile.'
Candesartan for Hypertension
The Medical Letter on Drugs and Therapeutics • November 20, 1998; (Issue 1040)
Candesartan cilexetil (Atacand - Astra) is the fourth angiotensin II receptor antagonist to become available in the USA for oral treatment of...
Candesartan cilexetil (Atacand - Astra) is the fourth angiotensin II receptor antagonist to become available in the USA for oral treatment of hypertension.
Lepirudin for Heparin-Induced Thrombocytopenia
The Medical Letter on Drugs and Therapeutics • September 25, 1998; (Issue 1036)
Lepirudin (Refludan - Hoechst Marion Roussel), a direct inhibitor of thrombin, has been approved by the FDA for use as an anticoagulant in patients with heparin-induced thrombocytopenia and thromboembolic...
Lepirudin (Refludan - Hoechst Marion Roussel), a direct inhibitor of thrombin, has been approved by the FDA for use as an anticoagulant in patients with heparin-induced thrombocytopenia and thromboembolic complications.
Clopidogrel for Reduction of Atherosclerotic Events
The Medical Letter on Drugs and Therapeutics • June 5, 1998; (Issue 1028)
Clopidogrel bisulfate (Plavix - Bristol-Myers Squibb/Sanofi), a new thienopyridine antiplatelet agent similar to ticlopidine (Ticlid - Medical Letter, 34:65, 1992), has been approved by the US Food and Drug...
Clopidogrel bisulfate (Plavix - Bristol-Myers Squibb/Sanofi), a new thienopyridine antiplatelet agent similar to ticlopidine (Ticlid - Medical Letter, 34:65, 1992), has been approved by the US Food and Drug Administration (FDA) for secondary prevention of myocardial infarction, stroke and other vascular events.
Raloxifene for Postmenopausal Osteoporosis
The Medical Letter on Drugs and Therapeutics • March 13, 1998; (Issue 1022)
Raloxifene (Evista - Lilly), a benzothiophene that acts on estrogen receptors, has recently been marketed for prevention of postmenopausal osteoporosis. Only estrogen (alone or in combination with a progestin)...
Raloxifene (Evista - Lilly), a benzothiophene that acts on estrogen receptors, has recently been marketed for prevention of postmenopausal osteoporosis. Only estrogen (alone or in combination with a progestin) and the bisphosphonate alendronate (Fosamax) were previously approved by the FDA for this indication.
Trovafloxacin
The Medical Letter on Drugs and Therapeutics • March 13, 1998; (Issue 1022)
Trovafloxacin (Trovan - Pfizer) and its prodrug alatrofoxacin (Trovan IV) are new fluroroquinolones marketed for an unusually wide variety of infections, including oral and intravenous treatment of nosocomial...
Trovafloxacin (Trovan - Pfizer) and its prodrug alatrofoxacin (Trovan IV) are new fluroroquinolones marketed for an unusually wide variety of infections, including oral and intravenous treatment of nosocomial and community-acquired pneumonia, acute ecerbations of chronic bronchitis, acute sinusitis, complicate intra-abdominal and pelvic infections, diabetic foot infection, uncomplicated urinary tract infection, prostatitis, cervicitis and uncomplicated gonorrhea.
Cerivastatin for Hypercholesterolemia
The Medical Letter on Drugs and Therapeutics • January 16, 1998; (Issue 1018)
Cerivastatin (Baycol - Bayer), a new HMG-CoA reductase inhibitor (or "statin"), has been approved by the FDA for treatment of hypercholesterolemia. Cerivastatin is the sodium salt of a synthetic fluorophenyl...
Cerivastatin (Baycol - Bayer), a new HMG-CoA reductase inhibitor (or "statin"), has been approved by the FDA for treatment of hypercholesterolemia. Cerivastatin is the sodium salt of a synthetic fluorophenyl pyridinyl-substituted heptanoic acid.
Ardeparin and Danaparoid for Prevention of Deep Vein Thrombosis
The Medical Letter on Drugs and Therapeutics • October 10, 1997; (Issue 1011)
Ardeparin sodium (Normiflo - Wyeth-Ayerst), a low-molecular-weight heparin, and danaparoid sodium (Orgaran - Organon), a heparinoid, have been approved by the FDA for prevention of deep vein thrombosis....
Ardeparin sodium (Normiflo - Wyeth-Ayerst), a low-molecular-weight heparin, and danaparoid sodium (Orgaran - Organon), a heparinoid, have been approved by the FDA for prevention of deep vein thrombosis. Without anticoagulation, deep vein thrombosis occurs in up to 30% of patients after abdominal surgery, and in 40% to 70% of patients after major orthopedic operations on the lower limbs. Danaparoid sodium is approved in the USA only for use in hip replacement. Ardeparin is approved here only for use in knee replacement.
Donepezil (Aricept) for Alzheimer's Disease
The Medical Letter on Drugs and Therapeutics • June 6, 1997; (Issue 1002)
Donepezil hydrochloride (Aricept - Eisai), a piperidine-based acetylcholinesterase inhibitor, is now being marketed for oral treatment of cognitive symptoms in patients with mild to moderate dementia due to...
Donepezil hydrochloride (Aricept - Eisai), a piperidine-based acetylcholinesterase inhibitor, is now being marketed for oral treatment of cognitive symptoms in patients with mild to moderate dementia due to Alzheimer's disease. Donepezil is the second drug approved for this indication; tacrine hydrochloride (Cognex), also an acetylcholinesterase inhibitor, has been available in the USA for four years (Medical Letter, 35:87, 1993).
Zileuton for Asthma
The Medical Letter on Drugs and Therapeutics • February 28, 1997; (Issue 995)
Zileuton (zye loo' ton; Zyflo - Abbott), an inhibitor of leukotriene synthesis, has been approved by the US Food and Drug Administration (FDA) for prophylaxis and maintenance treatment of chronic asthma in...
Zileuton (zye loo' ton; Zyflo - Abbott), an inhibitor of leukotriene synthesis, has been approved by the US Food and Drug Administration (FDA) for prophylaxis and maintenance treatment of chronic asthma in adults and children more than 12 years old. A related drug—zafirlukast (Accolate), a leukotriene receptor antagonist—was recently reviewed in the Medical Letter (vol. 38, page 111, December 20, 1996). Neither of these drugs is recommended for treatment of acute asthma.
Drugs for Treatment of Peptic Ulcers
The Medical Letter on Drugs and Therapeutics • January 3, 1997; (Issue 991)
Most peptic ulcers not caused by nonsteroidal anti-inflammatory drugs (NSAIDs) are now thought to be associated with infection of the gastric mucosa by the gram-negative bacilli Helicobacter pylori. The...
Most peptic ulcers not caused by nonsteroidal anti-inflammatory drugs (NSAIDs) are now thought to be associated with infection of the gastric mucosa by the gram-negative bacilli Helicobacter pylori. The majority of NSAID-related ulcers are gastric. H. pylori have been associated with both duodenal and gastric ulcers. Eradication of H. pylori promotes healing and markedly decreases recurrence of both duodenal and gastric ulcers (AH Soll, JAMA, 275:622, 1996).
Zafirlukast for Asthma
The Medical Letter on Drugs and Therapeutics • December 20, 1996; (Issue 990)
Zafirlukast (za fir loo kast; Accolate - Zeneca), the first leukotriene receptor anta-gonist approved by the US Food and Drug Administration, is now being heavily promoted for oral maintenance treatment of...
Zafirlukast (za fir loo kast; Accolate - Zeneca), the first leukotriene receptor anta-gonist approved by the US Food and Drug Administration, is now being heavily promoted for oral maintenance treatment of chronic asthma in patients more than 12 years old. It is not recommended for treatment of acute asthma.
Terbinafine for Onychomycosis
The Medical Letter on Drugs and Therapeutics • August 16, 1996; (Issue 981)
Terbinafine (Lamisil - Sandoz), an allylamine synthetic antifungal, previously available in the USA in a topical formulation (Medical Letter, 35:76, 1993) has now been marketed for oral use in the treatment...
Terbinafine (Lamisil - Sandoz), an allylamine synthetic antifungal, previously available in the USA in a topical formulation (Medical Letter, 35:76, 1993) has now been marketed for oral use in the treatment of fungal nail infections caused by dermatophytes. Oral terbinafine has been available in Europe since 1992.
Over-the-counter H2-Receptor Antagonists for Heartburn
The Medical Letter on Drugs and Therapeutics • October 27, 1995; (Issue 960)
Patients may be asking their physicians about use of histamine H2-receptor antagonists for treatment and prevention of heartburn. Cimetidine and famotidine have recently been released for over-the-counter sale...
Patients may be asking their physicians about use of histamine H2-receptor antagonists for treatment and prevention of heartburn. Cimetidine and famotidine have recently been released for over-the-counter sale and are being heavily advertised on television and in the print media.
Drugs For Tuberculosis
The Medical Letter on Drugs and Therapeutics • August 4, 1995; (Issue 954)
Tuberculosis (TB) continues to be a major problem in the United States, particularly in areas where drug resistance is common (Morbid Mortal Weekly Rep, 44:387, May 26, 1995). Since poor compliance is the...
Tuberculosis (TB) continues to be a major problem in the United States, particularly in areas where drug resistance is common (Morbid Mortal Weekly Rep, 44:387, May 26, 1995). Since poor compliance is the most important cause of treatment failure and is associated with emergence of drug resistence, some experts now recommend that all patients take drugs for TB under direct observation (SE Weis et al, N Engl J Med, 330:1179, 1994; R Bayer and D Wilkinson, Lancet, 345:1545, June 17, 1995).
Fluvoxamine for Obsessive-Compulsive Disorder
The Medical Letter on Drugs and Therapeutics • February 17, 1995; (Issue 942)
Fluvoxamine (Luvox - Solvay), a selective serotonin reuptake inhibitor (SSRI), has been approved for treatment of obsessive-compulsive disorder (OCD) by the US Food and Drug Administration. Fluoxetine...
Fluvoxamine (Luvox - Solvay), a selective serotonin reuptake inhibitor (SSRI), has been approved for treatment of obsessive-compulsive disorder (OCD) by the US Food and Drug Administration. Fluoxetine (Prozac), another SSRI antidepressant, and clomipramine (Anafranil), a tricyclic antidepressant that also inhibits serotonin reuptake, are the only other drugs available for this indication in the USA. Antidepressants that do not inhibit serotonin reuptake have not been effective for treatment of this condition.
Drugs for Treatment of Peptic Ulcers
The Medical Letter on Drugs and Therapeutics • July 22, 1994; (Issue 927)
Most peptic ulcers not caused by nonsteroidal anti-inflammatory drugs (NSAIDs) are now thought to be associated with infection of the gastric mucosa by the gram-negative bacilli Helicobacter pylori (NIH...
Most peptic ulcers not caused by nonsteroidal anti-inflammatory drugs (NSAIDs) are now thought to be associated with infection of the gastric mucosa by the gram-negative bacilli Helicobacter pylori (NIH Consensus Development Panel, JAMA, 272:65, July 6, 1994). NSAID-related ulcers are usually gastric. H. pylori have been associated with both duodenal and gastric ulcers.
Drugs for Tuberculosis
The Medical Letter on Drugs and Therapeutics • October 29, 1993; (Issue 908)
The rising incidence of tuberculosis (TB) has been accompanied by a dramatic increase in drug resistance in some areas of the USA (TR Frieden et al, N Engl J Med, 328:521, 1993). Since poor compliance is the...
The rising incidence of tuberculosis (TB) has been accompanied by a dramatic increase in drug resistance in some areas of the USA (TR Frieden et al, N Engl J Med, 328:521, 1993). Since poor compliance is the most important cause of treatment failure and associated with emergence of drug resistance, some experts now recommend that patients with TB take their drugs under direct obeservation (MD Iseman et al, N Engl J Med, 329:576, 1993).
Zolpidem For Insomnia
The Medical Letter on Drugs and Therapeutics • April 30, 1993; (Issue 895)
Zolpidem (Ambien - Searle), an imidazopyridine hypnotic available in Europe for several years, was recently approved by the US Food and Drug Administration for short-term treatment of...
Zolpidem (Ambien - Searle), an imidazopyridine hypnotic available in Europe for several years, was recently approved by the US Food and Drug Administration for short-term treatment of insomnia.
Choice of an Antidepressant
The Medical Letter on Drugs and Therapeutics • March 19, 1993; (Issue 892)
Since the introduction of fluoxetine (Prozac - Medical Letter, 30:45, 1988), bupropion (Wellbutrin - Medical Letter, 31:97, 1989), sertraline (Zoloft - Medical Letter, 34:47, 1992) and paroxetine (Paxil -...
Since the introduction of fluoxetine (Prozac - Medical Letter, 30:45, 1988), bupropion (Wellbutrin - Medical Letter, 31:97, 1989), sertraline (Zoloft - Medical Letter, 34:47, 1992) and paroxetine (Paxil - this issue), the choice of an antidepressant has become more difficult. Should these widely prescribed new drugs replace tricyclic antidepressants such as amitriptyline (Elavil, and others), imipramine (Tofranil, and others), or nortriptyline (Aventyl, and others) for treatment of most patients with depression?
Itraconazole
The Medical Letter on Drugs and Therapeutics • January 22, 1993; (Issue 888)
Itraconazole (Sporanox - Janssen), an antifungal triazole, has been approved by the US Food and Drug Administration (FDA) for oral treatment of histoplasmosis and blastomycosis. These two endemic mycoses...
Itraconazole (Sporanox - Janssen), an antifungal triazole, has been approved by the US Food and Drug Administration (FDA) for oral treatment of histoplasmosis and blastomycosis. These two endemic mycoses occur both in normal hosts and in immunocompromised patients, such as those with AIDS (RW Bradsher, Clin Infect Dis, 14:S82, 1992; LJ Wheat, Clin Infect Dis, 14:S91, 1992).
Drugs for Tuberculosis
The Medical Letter on Drugs and Therapeutics • February 7, 1992; (Issue 863)
After many years of decline in the USA, the incidence of tuberculosis (TB) has recently increased, partly because the disease occurs more frequently in patients with human immunodeficiency virus (HIV) infection...
After many years of decline in the USA, the incidence of tuberculosis (TB) has recently increased, partly because the disease occurs more frequently in patients with human immunodeficiency virus (HIV) infection and in the homeless (PF Barnes et al, N Engl J Med, 324:1644, 1991; Morbid Mortal Weekly Rep, 40:869, Dec 20, 1991).
Drugs For Treatment of Peptic Ulcers
The Medical Letter on Drugs and Therapeutics • November 29, 1991; (Issue 858)
Drugs that accelerate healing and prevent relapse or reurrence of peptic ulcers act either by decreasing gastric acidity or by enhancing mucosal defense mechanisms. Risk factors that may cause breakdown of...
Drugs that accelerate healing and prevent relapse or reurrence of peptic ulcers act either by decreasing gastric acidity or by enhancing mucosal defense mechanisms. Risk factors that may cause breakdown of mucosal defenses include the use of aspirinor other nonsteroidal anti-inflammatory drugs (NSAIDs) and the presence of Helicobacter pylori bacterial in the gastric antrum (AH Soll, Engl J Med, 322:909, 1990; WL Peterson, N Engl J Med, 324:1043, 1991).
Intravenous Ciprofloxacin
The Medical Letter on Drugs and Therapeutics • August 9, 1991; (Issue 850)
Ciprofloxacin, previously available orally (Cipro - Medical Letter, 30:11, 1988) and for ophthalmic use (Ciloxan - Medical Letter, 33:52, May 31, 1991), is now the first fluoroquinolone antibiotic to become...
Ciprofloxacin, previously available orally (Cipro - Medical Letter, 30:11, 1988) and for ophthalmic use (Ciloxan - Medical Letter, 33:52, May 31, 1991), is now the first fluoroquinolone antibiotic to become available in the USA in an intravenous (IV) formulation. Cipro I.V. (Miles) is being promoted as an alternative to third-generation cephalosporins, aminoglycosides, and other drugs used for treatment of serious infections.
Ofloxacin
The Medical Letter on Drugs and Therapeutics • July 26, 1991; (Issue 849)
Ofloxacin (Floxin - McNeil, Ortho), a new fluoroquinolone antibacterial agent, was recently marketed in the USA for oral treatment of various infections caused by susceptible microorganisms. Ofloxacin is the...
Ofloxacin (Floxin - McNeil, Ortho), a new fluoroquinolone antibacterial agent, was recently marketed in the USA for oral treatment of various infections caused by susceptible microorganisms. Ofloxacin is the third fluoroquinolone to become available in this country. Norfloxacin (Noroxin - Medical Letter, 29:25, 1987) is marketed only for treatment of urinary tract infections. Ciprofloxacin (Cipro - Medical Letter, 30:11, 1988), like ofloxacin, is approved for use in a variety of infections.
Fluoxetine (Prozac) Revisited
The Medical Letter on Drugs and Therapeutics • September 7, 1990; (Issue 826)
In the short time since fluoxetine (Prozac - Lilly) first became available in the USA (Medical Letter, 30:45, 1988), it has become the most frequently prescribed of all antidepressants. Some recent reports,...
In the short time since fluoxetine (Prozac - Lilly) first became available in the USA (Medical Letter, 30:45, 1988), it has become the most frequently prescribed of all antidepressants. Some recent reports, however, have questioned its safety.
Drugs for Treatment of Fungal Infections
The Medical Letter on Drugs and Therapeutics • June 15, 1990; (Issue 820)
...
Fluconazole
The Medical Letter on Drugs and Therapeutics • May 18, 1990; (Issue 818)
Fluconazole (Diflucan - Roerig), an antifungal azole, was recently approved by the US Food and Drug Administration for oral and intravenous (IV) treatment of cryptococcal meningitis and various forms of...
Fluconazole (Diflucan - Roerig), an antifungal azole, was recently approved by the US Food and Drug Administration for oral and intravenous (IV) treatment of cryptococcal meningitis and various forms of candidiasis. Both cryptococcal meningitis and candidiasis occur frequently in patients with AIDS, organ transplants, or cancer.
Propafenone for Cardiac Arrhythmia
The Medical Letter on Drugs and Therapeutics • April 20, 1990; (Issue 816)
Propafenone (Rythmol - Knoll), a class IC antiarrhythmic drug used in Europe for treatment of various arrhythmias for more than 10 years, was recently marketed in the USA for oral treatment of...
Propafenone (Rythmol - Knoll), a class IC antiarrhythmic drug used in Europe for treatment of various arrhythmias for more than 10 years, was recently marketed in the USA for oral treatment of life-threatening ventricular arrhythmias such as sustained ventricular tachycardia. This restrictive labeling reflects concerns arising from the interim report of the Cardiac Arrhythmia Suppression Trial, in which post-myocardial infarction patients with asymptomatic or mildly symptomatic ventricular arrhythmias treated with the class IC antiarrhythmic drugs encainide (Enkaid) or flecainide (Tambocor) had a higher mortality rate than patients taking placebo (CAST, N Engl J Med, 321:406, 1989).
Drugs For Treatment of Deep Fungal Infections
The Medical Letter on Drugs and Therapeutics • March 11, 1988; (Issue 761)
The incidence of opportunistic deep fungal infections continues to increase, particularly among patients who have AIDS, are taking immunosuppressive drugs, or are in intensive care...
The incidence of opportunistic deep fungal infections continues to increase, particularly among patients who have AIDS, are taking immunosuppressive drugs, or are in intensive care units.
Ciprofloxacin
The Medical Letter on Drugs and Therapeutics • January 29, 1988; (Issue 758)
Ciprofloxacin hydrochloride (Cipro - Miles), a synthetic antibacterial agent, was recently marketed in the USA for oral treatment of a wide variety of infections. Ciprofloxacin is the second fluoroquinolone...
Ciprofloxacin hydrochloride (Cipro - Miles), a synthetic antibacterial agent, was recently marketed in the USA for oral treatment of a wide variety of infections. Ciprofloxacin is the second fluoroquinolone to become available in this country; norfloxacin (Noroxin - Medical Letter, 29:25, 1987) is marketed only for treatment of urinary tract infections. Fluoroquinolones are more potent and have a much broader spectrum of activity than older quinolones such as nalidixic acid (NegGram).