The FDA has approved daprodustat (Jesduvroq – GSK), a hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI), for oral treatment of anemia due to chronic kidney disease (CKD) in adults who have been on dialysis for at least 4 months. It is the first HIF-PHI and the first oral drug to be approved in the US for this indication.

The FDA has approved the erythropoiesis-stimulating agent (ESA) peginesatide (Omontys – Affymax/Takeda), a synthetic peptide analog of erythropoietin, for treatment of anemia in patients with chronic kidney disease (CKD) who are on dialysis. Peginesatide is the third ESA to become available in the US.Overuse of the other two, which have broader indications, has been a concern.

Many drugs can cause psychiatric symptoms, but a causal connection is often difficult to establish. Psychiatric symptoms that emerge during drug treatment could also be due to the underlying illness, previously unrecognized psychopathology, or psychosocial factors. The withdrawal of some drugs can cause symptoms such as anxiety, psychosis, delirium, agitation or depression.

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The drugs of choice for treatment of non-HIV viral infections with their dosages and cost are listed in Tables 1-6. Some of the indications and dosages recommended here have not been approved by the FDA. Vaccines used in the prevention of viral infections are discussed in the "Adult Immunization" issue of Treatment Guidelines.

The erythropoiesis-stimulating agents (ESAs) epoetin alfa (Epogen, Procrit) and darbepoetin alfa (Aranesp) are widely used for treatment of anemia and to reduce the need for red blood cell transfusions. Based on the results of recent clinical trials indicating an increased risk of serious adverse events and death associated with ESAs, particularly when used to achieve a hemoglobin concentration ≥12 g/dL, the FDA has revised the prescribing information for these drugs to include a black box warning.

The drugs of choice for non-HIV viral infections with their dosages and cost are listed in the tables that begin on page 24. Some of the indications and dosages recommended here have not been approved by the FDA.

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?

Many drugs can cause psychiatric symptoms, but a causal connection is often difficult to establish. Psychiatric symptoms that emerge during drug treatment may also be due to the underlying illness, previously unrecognized psychopathology, or psychosocial factors. The withdrawal of some drugs can cause symptoms such as anxiety, psychosis, delirium, agitation or depression.

Darbepoetin alfa (Aranesp) has been approved by the FDA for treatment of anemia caused by chronic renal disease and will probably also be approved for use in patients with cancer..

Use of epoetin alfa, a recombinant human erythropoietin, is being promoted directly to consumers in vague advertisements that promise renewed energy and improved work capacity. Epoetin is approved by the FDA for treatment of anemia due to chronic renal failure, cancer chemotherapy or HIV treatment, and before elective non-cardiac surgery. It is also used illicitly by competitive athletes to increase their endurance.

The drugs of choice for treatment of deep fungal infections are listed in the table below. Some of the indications and dosages recommended here have not been approved by the FDA.

Midodrine hydrochloride (ProAmatine - Roberts), an alpha1-selective adrenergic agonist, is now available for treatment of severe symptomatic orthostatic hypotension. Other treatments for this condition include other sympathomimetics, constrictive garments, erythropoietin (Epogen; Procrit) and fludrocortisone with salt (D Robertson and TL Davis, Neurology, 45 suppl 5: S26, 1995).

The drugs of choice for treatment of deep fungal infections are listed in the table on page 101. Some of the indications and dosages recommended here have not been approved by the US Food and Drug Administration. More detailed guidelines are available from the Infectious Diseases Society of America (J Sobel et al, Clin Infect Dis, volume 30, April 2000).

Results of recently completed clinical trials have led to some changes in recommendations for treatment of human immunodeficiency virus (HIV) and other infections associted with AIDS.

A growing number of clinical trials now permits some consensus on the treatment of human immunodeficiency virus (HIV) and other infections associated with acquired immune deficiency syndrome (AIDS) in adults.

Production of erythropoietin, a glycoprotein hormone secreted mainly by the kidney, is often low in patients with chronic renal failure (JW Eschbach, Kidney Int, 35:134, 1989). The US Food and Drug Administration recently approved marketing of epoetin alfa (Epogen - Amgen), a recombinant human erythropoietin, for treatment of anemia in such patients. Epoetin is commercially available in Europe as Eprex (Ortho), and Eprex is available from Ortho in the USA on an investigational basis for treatment of anemia related to AIDS. Epogen and Eprex are chemically identical.