Matching articles for "topiramate"
Ganaxolone (Ztalmy) for CDKL5 Deficiency Disorder (online only)
The Medical Letter on Drugs and Therapeutics • August 19, 2024; (Issue 1709)
The FDA has approved ganaxolone (Ztalmy – Marinus)
for oral treatment of seizures associated with cyclin-dependent
kinase-like 5 (CDKL5) deficiency disorder
in patients ≥2 years old. It is the first drug...
The FDA has approved ganaxolone (Ztalmy – Marinus)
for oral treatment of seizures associated with cyclin-dependent
kinase-like 5 (CDKL5) deficiency disorder
in patients ≥2 years old. It is the first drug to be
approved in the US for this indication.
Comparison Table: Some Oral Antiseizure Medications (online only)
The Medical Letter on Drugs and Therapeutics • August 5, 2024; (Issue 1708)
...
View the Comparison Table: Some Oral Antiseizure Medications
Drugs for Epilepsy
The Medical Letter on Drugs and Therapeutics • August 5, 2024; (Issue 1708)
When used for the appropriate seizure type,
antiseizure medications (ASMs) are roughly
equivalent in efficacy. In addition to the seizure type,
the choice of drug is usually based on factors such
as ease of...
When used for the appropriate seizure type,
antiseizure medications (ASMs) are roughly
equivalent in efficacy. In addition to the seizure type,
the choice of drug is usually based on factors such
as ease of use, spectrum of activity, adverse effects,
interactions with other drugs, presence of comorbid
conditions, suitability for elderly persons and those
with childbearing potential, and cost. Treatment
should begin with a single drug, increasing the
dosage gradually until seizures are controlled or
adverse effects become unacceptable. If seizures
persist, expert clinicians generally try at least one and
sometimes a second alternative drug as monotherapy
before considering use of two drugs at the same time.
Comparison Table: Some Drugs for Migraine Prevention in Adults (online only)
The Medical Letter on Drugs and Therapeutics • June 12, 2023; (Issue 1678)
...
View the Comparison Table: Some Drugs for Migraine Prevention in Adults
Drugs for Migraine
The Medical Letter on Drugs and Therapeutics • June 12, 2023; (Issue 1678)
An oral nonopioid analgesic is often sufficient for
acute treatment of mild to moderate migraine pain
without severe nausea or vomiting. A triptan is the
drug of choice for treatment of moderate to...
An oral nonopioid analgesic is often sufficient for
acute treatment of mild to moderate migraine pain
without severe nausea or vomiting. A triptan is the
drug of choice for treatment of moderate to severe
migraine in most patients without vascular disease.
Treatment of pain when it is still mild to moderate in
intensity improves headache response and reduces
the risk of recurrence.
In Brief: Semaglutide (Wegovy) for Weight Loss in Children
The Medical Letter on Drugs and Therapeutics • February 20, 2023; (Issue 1670)
The injectable glucagon-like peptide-1 (GLP-1)
receptor agonist semaglutide (Wegovy), which was
approved by the FDA in 2021 for chronic weight
management in adults, has now been approved for
chronic weight...
The injectable glucagon-like peptide-1 (GLP-1)
receptor agonist semaglutide (Wegovy), which was
approved by the FDA in 2021 for chronic weight
management in adults, has now been approved for
chronic weight management in children ≥12 years old
with an initial BMI in the ≥95th percentile for age and
sex.Semaglutide is also available as Ozempic and
Rybelsus for treatment of type 2 diabetes in adults.
Drugs and Devices for Weight Management
The Medical Letter on Drugs and Therapeutics • May 30, 2022; (Issue 1651)
Adults with a body mass index (BMI) between 25
and 29.9 kg/m2 are considered overweight. Those
with a BMI ≥30 are considered obese. The initial
recommendation for any weight loss effort is to
achieve a...
Adults with a body mass index (BMI) between 25
and 29.9 kg/m2 are considered overweight. Those
with a BMI ≥30 are considered obese. The initial
recommendation for any weight loss effort is to
achieve a 5-10% reduction in weight, which has been
associated with a reduction in the risk of developing
type 2 diabetes, hypertension, and dyslipidemia. Diet,
exercise, and behavior modification are the preferred
methods for losing weight, but long-term weight
maintenance can be difficult. Several drugs and
devices are FDA-approved for weight reduction and
maintenance of weight loss.
Comparison Table: Some FDA-Approved Drugs for Weight Management (online only)
The Medical Letter on Drugs and Therapeutics • May 30, 2022; (Issue 1651)
...
View the Comparison Table: Some FDA-Approved Drugs for Weight Management
Drugs for Alcohol Use Disorder
The Medical Letter on Drugs and Therapeutics • December 13, 2021; (Issue 1639)
Consumption of alcohol has increased during the
COVID-19 pandemic. The Diagnostic and Statistical
Manual for Mental Disorders, 5th edition (DSM-5) defines
alcohol use disorder (AUD; previously called...
Consumption of alcohol has increased during the
COVID-19 pandemic. The Diagnostic and Statistical
Manual for Mental Disorders, 5th edition (DSM-5) defines
alcohol use disorder (AUD; previously called alcohol
dependence) as meeting ≥2 of the 11 criteria listed in
Table 1 in the past year. The lifetime prevalence of AUD
in the US population has been estimated to be about
30%. Despite this high prevalence and the associated
morbidity, mortality, and costs, only 3 drugs are FDA-approved
for treatment of the disorder.
Atogepant (Qulipta) for Migraine Prevention
The Medical Letter on Drugs and Therapeutics • November 1, 2021; (Issue 1636)
Atogepant (Qulipta – Abbvie), an oral small-molecule
calcitonin gene-related peptide (CGRP) receptor
antagonist ("gepant"), has been approved by the
FDA for prevention of episodic migraine in adults....
Atogepant (Qulipta – Abbvie), an oral small-molecule
calcitonin gene-related peptide (CGRP) receptor
antagonist ("gepant"), has been approved by the
FDA for prevention of episodic migraine in adults. It
is the second oral CGRP receptor antagonist to be
approved in the US for this indication; the first was
rimegepant (Nurtec ODT), which is also approved
for acute treatment of migraine. Parenteral CGRP
monoclonal antibodies are approved for prevention
of migraine (see Table 3).
Fenfluramine (Fintepla) for Dravet Syndrome
The Medical Letter on Drugs and Therapeutics • August 9, 2021; (Issue 1630)
The FDA has approved fenfluramine oral solution
(Fintepla – Zogenix) for treatment of seizures in
patients ≥2 years old with Dravet syndrome. It is the
third drug to be approved for this indication....
The FDA has approved fenfluramine oral solution
(Fintepla – Zogenix) for treatment of seizures in
patients ≥2 years old with Dravet syndrome. It is the
third drug to be approved for this indication. Stiripentol
(Diacomit) and cannabidiol (Epidiolex), a purified
product derived from marijuana, were approved earlier.
Semaglutide (Wegovy) for Weight Loss
The Medical Letter on Drugs and Therapeutics • July 12, 2021; (Issue 1628)
The injectable glucagon-like peptide-1 (GLP-1)
receptor agonist semaglutide, previously approved
by the FDA as Ozempic to treat type 2 diabetes and
to reduce the risk of major adverse cardiovascular
events...
The injectable glucagon-like peptide-1 (GLP-1)
receptor agonist semaglutide, previously approved
by the FDA as Ozempic to treat type 2 diabetes and
to reduce the risk of major adverse cardiovascular
events in adults with type 2 diabetes and established
cardiovascular disease, has now been approved in
a higher dose as Wegovy (Novo Nordisk) for chronic
weight management in adults with or without type 2
diabetes who have a body mass index (BMI) ≥30 kg/m2
or a BMI ≥27 kg/m2 and ≥1 weight-related comorbidity
(e.g., hypertension, dyslipidemia). An oral formulation
of semaglutide (Rybelsus) has been available since
2019 for treatment of type 2 diabetes, but it is not
approved for weight management. Liraglutide
(Saxenda), another subcutaneously injected GLP-1
receptor agonist, was approved for chronic weight
management in 2015.
Semaglutide (Ozempic) for Weight Loss
The Medical Letter on Drugs and Therapeutics • April 5, 2021; (Issue 1621)
In recently published clinical trials, once-weekly
subcutaneous injection of the glucagon-like peptide 1
(GLP-1) receptor agonist semaglutide (Ozempic – Novo Nordisk), which is FDA-approved for treatment...
In recently published clinical trials, once-weekly
subcutaneous injection of the glucagon-like peptide 1
(GLP-1) receptor agonist semaglutide (Ozempic – Novo Nordisk), which is FDA-approved for treatment of
type 2 diabetes and to reduce the risk of major adverse
cardiovascular events in adults with type 2 diabetes
and established cardiovascular disease, has reduced
body weight significantly in patients with and without
type 2 diabetes when given in addition to lifestyle
intervention. Liraglutide (Saxenda), another GLP-1
receptor agonist, has been FDA-approved for chronic
weight management since 2015.
Stiripentol (Diacomit) for Dravet Syndrome (online only)
The Medical Letter on Drugs and Therapeutics • March 24, 2021; (Issue 1620)
The FDA has approved stiripentol (Diacomit – Biocodex)
for treatment of seizures in patients ≥2 years old with
Dravet syndrome who are also taking clobazam (Onfi).
Stiripentol, which has been available...
The FDA has approved stiripentol (Diacomit – Biocodex)
for treatment of seizures in patients ≥2 years old with
Dravet syndrome who are also taking clobazam (Onfi).
Stiripentol, which has been available in Europe, Canada,
and Japan for many years, is the second drug to be
approved in the US for this indication; cannabidiol oral
solution (Epidiolex), a purified marijuana product, was
the first.
Drugs for Migraine
The Medical Letter on Drugs and Therapeutics • October 5, 2020; (Issue 1608)
An oral nonopioid analgesic is often sufficient for acute
treatment of mild to moderate migraine headache
without severe nausea or vomiting. A triptan is the
drug of choice for treatment of moderate to...
An oral nonopioid analgesic is often sufficient for acute
treatment of mild to moderate migraine headache
without severe nausea or vomiting. A triptan is the
drug of choice for treatment of moderate to severe
migraine headache pain in most patients without
vascular disease. Early treatment of pain when it is
still mild to moderate in intensity improves headache
response and reduces the risk of recurrence.
Eptinezumab (Vyepti) for Migraine Prevention
The Medical Letter on Drugs and Therapeutics • June 1, 2020; (Issue 1599)
The FDA has approved eptinezumab-jjmr (Vyepti –
Lundbeck), a calcitonin gene-related peptide (CGRP)
antagonist administered IV once every 3 months, for
migraine prevention in adults. It is the fourth...
The FDA has approved eptinezumab-jjmr (Vyepti –
Lundbeck), a calcitonin gene-related peptide (CGRP)
antagonist administered IV once every 3 months, for
migraine prevention in adults. It is the fourth monoclonal
antibody to be approved for this indication; erenumab
(Aimovig), fremanezumab (Ajovy), and galcanezumab
(Emgality), which are all given subcutaneously once
monthly (fremanezumab can also be given once every 3
months), were approved earlier.
Fremanezumab (Ajovy) and Galcanezumab (Emgality) for Migraine Prevention
The Medical Letter on Drugs and Therapeutics • November 5, 2018; (Issue 1559)
The FDA has approved two subcutaneously
injected calcitonin gene-related peptide (CGRP)
antagonists, fremanezumab-vfrm (Ajovy – Teva) and
galcanezumab-gnlm (Emgality – Lilly), for migraine
prevention in...
The FDA has approved two subcutaneously
injected calcitonin gene-related peptide (CGRP)
antagonists, fremanezumab-vfrm (Ajovy – Teva) and
galcanezumab-gnlm (Emgality – Lilly), for migraine
prevention in adults. Fremanezumab and galcanezumab
are the second and third subcutaneously
injected monoclonal antibodies that target the CGRP
pathway to be approved by the FDA for this indication;
erenumab-aooe (Aimovig), which targets the CGRP
receptor, was the first.
Cannabidiol (Epidiolex) for Epilepsy
The Medical Letter on Drugs and Therapeutics • November 5, 2018; (Issue 1559)
The FDA has approved cannabidiol oral solution
(Epidiolex – Greenwich Biosciences) for treatment
of seizures associated with Dravet syndrome or
Lennox-Gastaut syndrome in patients ≥2 years...
The FDA has approved cannabidiol oral solution
(Epidiolex – Greenwich Biosciences) for treatment
of seizures associated with Dravet syndrome or
Lennox-Gastaut syndrome in patients ≥2 years old.
Cannabidiol (CBD) is a cannabinoid constituent of
the marijuana plant (Cannabis sativa). It is the first
natural marijuana product to be approved by the FDA
for any indication and the first drug to be approved in
the US for treatment of Dravet syndrome. Stiripentol
(Diacomit), which is not a marijuana product, was also
recently approved by the FDA for treatment of Dravet
syndrome in combination with clobazam (Onfi) and
will be reviewed in a future issue.
Erenumab (Aimovig) for Migraine Prevention
The Medical Letter on Drugs and Therapeutics • June 18, 2018; (Issue 1549)
The FDA has approved erenumab-aooe (Aimovig –
Amgen/Novartis), a once-monthly, subcutaneously-injected,
monoclonal antibody against the calcitonin
gene-related peptide receptor, for preventive...
The FDA has approved erenumab-aooe (Aimovig –
Amgen/Novartis), a once-monthly, subcutaneously-injected,
monoclonal antibody against the calcitonin
gene-related peptide receptor, for preventive treatment
of migraine in adults. It is the first drug in its class to
be approved by the FDA.
Drugs for Epilepsy
The Medical Letter on Drugs and Therapeutics • July 31, 2017; (Issue 1526)
Treatment of epilepsy should begin with a single
antiepileptic drug (AED), increasing its dosage
gradually until seizures are controlled or adverse
effects become intolerable. If seizures...
Treatment of epilepsy should begin with a single
antiepileptic drug (AED), increasing its dosage
gradually until seizures are controlled or adverse
effects become intolerable. If seizures persist,
specialists generally recommend trying at least
one and sometimes a second alternative drug as
monotherapy before considering use of two drugs
concurrently. When used for the appropriate seizure
type, AEDs are roughly equivalent in efficacy. Drug
choice is usually based on factors such as ease of
use, adverse effects, drug interactions, presence of
comorbidities, and cost.
Comparison Table: Some Oral Antiepileptic Drugs (online only)
The Medical Letter on Drugs and Therapeutics • July 31, 2017; (Issue 1526)
...
View the Comparison Table: Some Oral Antiepileptic Drugs
Exablate Neuro for Essential Tremor
The Medical Letter on Drugs and Therapeutics • March 27, 2017; (Issue 1517)
The FDA has approved use of Exablate Neuro (Insightec)
for unilateral thalamotomy to treat medication-refractory
essential tremor in patients ≥22 years old.
Exablate Neuro uses magnetic...
The FDA has approved use of Exablate Neuro (Insightec)
for unilateral thalamotomy to treat medication-refractory
essential tremor in patients ≥22 years old.
Exablate Neuro uses magnetic resonance-guided
focused ultrasound (MRgFUS) to create lesions in the
ventral intermediate nucleus of the thalamus. MRgFUS
is also approved in the US for treatment of uterine
fibroids and for pain palliation of bone metastases.
Drugs for Migraine
The Medical Letter on Drugs and Therapeutics • February 13, 2017; (Issue 1514)
An oral nonopioid analgesic may be sufficient for
treatment of mild to moderate migraine without severe
nausea or vomiting. A triptan is the drug of choice for
treatment of moderate to severe migraine. Use...
An oral nonopioid analgesic may be sufficient for
treatment of mild to moderate migraine without severe
nausea or vomiting. A triptan is the drug of choice for
treatment of moderate to severe migraine. Use of
a triptan early in an attack when pain is still mild to
moderate in intensity improves headache response
and reduces recurrence rates.
Comparison Table: Some Drugs for Migraine Prevention in Adults (online only)
The Medical Letter on Drugs and Therapeutics • February 13, 2017; (Issue 1514)
...
View the Comparison Table: Some Drugs for Migraine Prevention in Adults
In Brief: Phentermine (Lomaira) for Weight Loss
The Medical Letter on Drugs and Therapeutics • December 5, 2016; (Issue 1509)
The FDA has approved Lomaira (KVK Tech), an 8-mg tablet formulation of phentermine that can be taken up to three times daily before meals, as an adjunct to lifestyle modifications for weight loss. It is only...
The FDA has approved Lomaira (KVK Tech), an 8-mg tablet formulation of phentermine that can be taken up to three times daily before meals, as an adjunct to lifestyle modifications for weight loss. It is only approved for short-term use (a few weeks) in adults with a body mass index (BMI) ≥30 kg/m2, or with a BMI ≥27 kg/m2 in addition to a weight-related comorbidity such as hypertension, dyslipidemia, or diabetes. Phentermine has been available alone and in combination with topiramate for years.1
Lomaira was approved by the FDA under an abbreviated new drug application (ANDA) and is considered a generic drug. Its approval was based on the results of earlier phentermine trials. No studies are available comparing the efficacy and safety of Lomaira to standard doses of phentermine or to any other drug approved for weight loss.
Like other sympathomimetic amines approved for weight loss, Lomaira is classified as a schedule IV controlled substance. All sympathomimetics can increase heart rate, raise blood pressure, and cause nervousness and insomnia.2 Phentermine is contraindicated for use in patients with cardiovascular disease, hyperthyroidism, glaucoma, or a history of drug abuse, and in pregnant women. It should not be used while taking, and for 14 days after stopping, a monoamine oxidase (MAO) inhibitor because of the risk of hypertensive crisis.
Download complete U.S. English article
Lomaira was approved by the FDA under an abbreviated new drug application (ANDA) and is considered a generic drug. Its approval was based on the results of earlier phentermine trials. No studies are available comparing the efficacy and safety of Lomaira to standard doses of phentermine or to any other drug approved for weight loss.
Like other sympathomimetic amines approved for weight loss, Lomaira is classified as a schedule IV controlled substance. All sympathomimetics can increase heart rate, raise blood pressure, and cause nervousness and insomnia.2 Phentermine is contraindicated for use in patients with cardiovascular disease, hyperthyroidism, glaucoma, or a history of drug abuse, and in pregnant women. It should not be used while taking, and for 14 days after stopping, a monoamine oxidase (MAO) inhibitor because of the risk of hypertensive crisis.
- Diet, drugs, and surgery for weight loss. Med Lett Drugs Ther 2015; 57:21.
- SZ Yanovski and JA Yanovski. Long-term drug treatment for obesity: a systematic and clinical review. JAMA 2014; 311:74.
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Diet, Drugs, and Surgery for Weight Loss
The Medical Letter on Drugs and Therapeutics • February 16, 2015; (Issue 1462)
Adults with a body mass index (BMI) between
25 and 29.9 kg/m2 are considered overweight. Those
with a BMI ≥30 are considered obese. Losing even
a small amount of weight and increasing physical
activity...
Adults with a body mass index (BMI) between
25 and 29.9 kg/m2 are considered overweight. Those
with a BMI ≥30 are considered obese. Losing even
a small amount of weight and increasing physical
activity can prevent some of the complications
of obesity, particularly type 2 diabetes. Diet and
exercise are the preferred methods for losing weight,
but long-term failure rates are high. Several drugs
have been approved by the FDA for weight reduction,
but adherence is poor, adverse effects are common,
and patients usually regain the lost weight when
the drug is stopped. Bariatric surgery can produce
substantial weight loss and significantly reduce
obesity-related comorbidities; long-term data on its
safety are encouraging, but still limited. Guidelines
for the management of overweight or obese adults
have recently been published.
In Brief: Topiramate Extended-Release Capsules (Qudexy XR) (online only)
The Medical Letter on Drugs and Therapeutics • December 8, 2014; (Issue 1457)
The FDA has approved a new extended-release capsule formulation of topiramate (Qudexy XR – Upsher Smith), which can be opened and sprinkled on food for patients who have difficulty swallowing tablets or...
The FDA has approved a new extended-release capsule formulation of topiramate (Qudexy XR – Upsher Smith), which can be opened and sprinkled on food for patients who have difficulty swallowing tablets or capsules, for treatment of epilepsy. Qudexy XR was marketed as a branded drug in March 2014 and as a generic drug four months later. An earlier extended-release formulation (Trokendi XR) must be swallowed whole.
Trokendi XR is approved for initial monotherapy in patients ≥10 years old with partial-onset seizures or primary generalized tonic-clonic seizures and for adjunctive therapy in patients ≥6 years old with partial-onset seizures, primary generalized tonic-clonic seizures, or seizures associated with Lennox-Gastaut syndrome. Qudexy XR has been approved for the same indications, but the indication for adjunctive therapy has been extended to children ≥2 years old. Topiramate has been available for many years in immediate-release formulations (Topamax, and others) for the same indications for patients ≥2 years old. Trokendi XR and Qudexy XR both appear to be bioequivalent to immediate-release formulations of topiramate; whether they are bioequivalent to one another has not been established.
Download complete U.S. English article
Trokendi XR is approved for initial monotherapy in patients ≥10 years old with partial-onset seizures or primary generalized tonic-clonic seizures and for adjunctive therapy in patients ≥6 years old with partial-onset seizures, primary generalized tonic-clonic seizures, or seizures associated with Lennox-Gastaut syndrome. Qudexy XR has been approved for the same indications, but the indication for adjunctive therapy has been extended to children ≥2 years old. Topiramate has been available for many years in immediate-release formulations (Topamax, and others) for the same indications for patients ≥2 years old. Trokendi XR and Qudexy XR both appear to be bioequivalent to immediate-release formulations of topiramate; whether they are bioequivalent to one another has not been established.
Download complete U.S. English article
Contrave - A Combination of Bupropion and Naltrexone for Weight Loss
The Medical Letter on Drugs and Therapeutics • November 10, 2014; (Issue 1455)
The FDA has approved a fixed-dose combination of
the opioid receptor antagonist naltrexone (ReVia, and
others) and the antidepressant and smoking cessation
agent bupropion (Wellbutrin SR, Zyban, and...
The FDA has approved a fixed-dose combination of
the opioid receptor antagonist naltrexone (ReVia, and
others) and the antidepressant and smoking cessation
agent bupropion (Wellbutrin SR, Zyban, and others),
as Contrave (Orexigen/Takeda) for weight loss. The
combination was approved for use as an adjunct to
diet and increased physical activity in patients with a
body mass index (BMI) ≥30 kg/m2 or a BMI ≥27 kg/m2
and one or more weight-related comorbidities such as
hypertension, diabetes, or dyslipidemia. Naltrexone/bupropion is not a controlled substance.
Perampanel (Fycompa) for Epilepsy
The Medical Letter on Drugs and Therapeutics • February 3, 2014; (Issue 1435)
Perampanel (per am’ pa nel; Fycompa – Eisai), a first-in-class noncompetitive AMPA receptor antagonist, has
been approved by the FDA for adjunctive treatment of
partial-onset seizures in patients ≥12...
Perampanel (per am’ pa nel; Fycompa – Eisai), a first-in-class noncompetitive AMPA receptor antagonist, has
been approved by the FDA for adjunctive treatment of
partial-onset seizures in patients ≥12 years old. New
drugs for epilepsy are often initially approved by the
FDA as adjunctive treatment for partial seizures.
Drugs for Migraine
The Medical Letter on Drugs and Therapeutics • December 1, 2013; (Issue 136)
Treatment of migraine in the emergency department,
which may involve use of intravenous drugs, is not
discussed...
Treatment of migraine in the emergency department,
which may involve use of intravenous drugs, is not
discussed here.
Topiramate Extended-Release (Trokendi XR) for Epilepsy
The Medical Letter on Drugs and Therapeutics • October 28, 2013; (Issue 1428)
The FDA has approved a once-daily extended-release
(ER) formulation of the antiepileptic topiramate (Trokendi
XR – Supernus) for initial monotherapy in patients ≥10
years old with partial onset seizures...
The FDA has approved a once-daily extended-release
(ER) formulation of the antiepileptic topiramate (Trokendi
XR – Supernus) for initial monotherapy in patients ≥10
years old with partial onset seizures or primary generalized
tonic-clonic seizures and for adjunctive therapy in
patients ≥6 years old with partial onset seizures, primary
generalized tonic-clonic seizures, or seizures associated
with Lennox-Gastaut syndrome. Topiramate has been
available for many years as an immediate-release (IR)
formulation (Topamax, and generics) for the same indications
in patients ≥2 years old
Drugs for Epilepsy
The Medical Letter on Drugs and Therapeutics • February 1, 2013; (Issue 126)
Treatment of epilepsy should begin with a single
drug, increasing the dosage gradually until seizures
are controlled or adverse effects become unacceptable.
If seizures persist, expert clinicians...
Treatment of epilepsy should begin with a single
drug, increasing the dosage gradually until seizures
are controlled or adverse effects become unacceptable.
If seizures persist, expert clinicians generally
prescribe at least one and sometimes a second alternative
drug as monotherapy before considering use of
two drugs at the same time. When used for the appropriate
seizure type, antiepileptic drugs are roughly
equivalent in efficacy. The choice of drug is usually
based on factors such as ease of use, adverse effects,
interactions with other drugs, presence of comorbid
conditions and cost.
Two Drugs for Weight Loss
The Medical Letter on Drugs and Therapeutics • September 3, 2012; (Issue 1398)
In 2013 the FDA approved one new drug and a new combination of 2 old drugs as adjuncts to lifestyle changes for chronic weight management. Lorcaserin (lor-ca-SER-in; Belviq – Arena/Esai) is a selective...
In 2013 the FDA approved one new drug and a new combination of 2 old drugs as adjuncts to lifestyle changes for chronic weight management. Lorcaserin (lor-ca-SER-in; Belviq – Arena/Esai) is a selective serotonin 2C receptor agonist. Qsymia (Vivus) is a fixed-dose combination of the weight-loss drug phentermine and an extended-release (ER) formulation of topiramate. The new products are approved for use in obese patients (body mass index [BMI] of ≥30 kg/m2) and for patients who are overweight (BMI ≥27 kg/m2) and have one weight-related risk factor such as hypertension, dyslipidemia or type 2 diabetes.
Ezogabine (Potiga) for Epilepsy
The Medical Letter on Drugs and Therapeutics • August 20, 2012; (Issue 1397)
The FDA has approved ezogabine (ee-ZOE-ga-been;
Potiga – GSK/Valeant) for oral adjunctive treatment of
partial-onset seizures in adults. Ezogabine is available
in Europe as retigabine...
The FDA has approved ezogabine (ee-ZOE-ga-been;
Potiga – GSK/Valeant) for oral adjunctive treatment of
partial-onset seizures in adults. Ezogabine is available
in Europe as retigabine (Trobalt).
Diet, Drugs and Surgery for Weight Loss
The Medical Letter on Drugs and Therapeutics • April 1, 2011; (Issue 104)
...
Adults with a body mass index (BMI=kg/m2) of 25-<30 are considered overweight; those with a BMI of ≥30 are considered obese.
Drugs for Migraine
The Medical Letter on Drugs and Therapeutics • February 1, 2011; (Issue 102)
Drugs for treatment of migraine are listed in Table 2
on page 9. Drugs for prevention of migraine are listed
in Table 3 on page 10. Treatment of migraine in the
emergency room, which may involve use of...
Drugs for treatment of migraine are listed in Table 2
on page 9. Drugs for prevention of migraine are listed
in Table 3 on page 10. Treatment of migraine in the
emergency room, which may involve use of intravenous
drugs, is not included here.
Botulinum Toxin for Chronic Migraine
The Medical Letter on Drugs and Therapeutics • January 24, 2011; (Issue 1356)
The FDA has approved injection of onabotulinumtoxinA
(Botox – Allergan) for prevention of
headaches in adult patients with chronic migraine (≥15
headache days/month for ≥3 months). It is the...
The FDA has approved injection of onabotulinumtoxinA
(Botox – Allergan) for prevention of
headaches in adult patients with chronic migraine (≥15
headache days/month for ≥3 months). It is the first
drug approved for treatment of this indication. Botox is
also FDA-approved for treatment of upper limb spasticity,
axillary hyperhidrosis, cervical dystonia, blepharospasm
and strabismus, and for cosmetic
reduction of wrinkles.
Drugs for Pain
The Medical Letter on Drugs and Therapeutics • April 1, 2010; (Issue 92)
Pain can be acute or chronic. Chronic pain has been broadly classified into two types: nociceptive and neuropathic. Nociceptive pain can be treated with nonopioid analgesics or opioids. Neuropathic pain is less...
Pain can be acute or chronic. Chronic pain has been broadly classified into two types: nociceptive and neuropathic. Nociceptive pain can be treated with nonopioid analgesics or opioids. Neuropathic pain is less responsive to opioids; adjuvant medicines such as antidepressants and anticonvulsants are often used to treat neuropathic pain. Combining different types of analgesics may provide an additive analgesic effect without increasing adverse effects.
Vigabatrin (Sabril) for Epilepsy
The Medical Letter on Drugs and Therapeutics • February 22, 2010; (Issue 1332)
The FDA has approved vigabatrin (vye gá ba trin; Sabril – Lundbeck) for oral use as add-on therapy for complex partial seizures in adults who are refractory to several antiepileptic drugs and as monotherapy...
The FDA has approved vigabatrin (vye gá ba trin; Sabril – Lundbeck) for oral use as add-on therapy for complex partial seizures in adults who are refractory to several antiepileptic drugs and as monotherapy for infantile spasms. Vigabatrin has been available in other countries for many years. Because of its potential for retinal toxicity, it will be available in the US only through a restricted distribution program called SHARE (Support, Help and Resources for Epilepsy). Prescribers and pharmacists distributing the drug must register, and patients must undergo visual field testing.
Generic Drugs Revisited
The Medical Letter on Drugs and Therapeutics • October 19, 2009; (Issue 1323)
The equivalence of generic drugs to their brand-name precursors continues to be controversial. The last Medical Letter review of this subject (2002) concluded that well-documented therapeutic inequivalence...
The equivalence of generic drugs to their brand-name precursors continues to be controversial. The last Medical Letter review of this subject (2002) concluded that well-documented therapeutic inequivalence between brand-name and FDA-approved generic drugs had not been reported. Is that still true? New data have become available for some drugs.
Lacosamide for Epilepsy
The Medical Letter on Drugs and Therapeutics • June 29, 2009; (Issue 1315)
The FDA has approved lacosamide (Vimpat - UCB Pharma) for oral or intravenous (IV) use as add-on therapy in adults with partial-onset...
The FDA has approved lacosamide (Vimpat - UCB Pharma) for oral or intravenous (IV) use as add-on therapy in adults with partial-onset seizures.
Rufinamide (Banzel) for Epilepsy
The Medical Letter on Drugs and Therapeutics • March 9, 2009; (Issue 1307)
Rufinamide (Banzel - Eisai), a triazole derivative structurally unrelated to other marketed antiepileptic drugs (AEDs), has been approved by the FDA for treatment of seizures associated with Lennox-Gastaut...
Rufinamide (Banzel - Eisai), a triazole derivative structurally unrelated to other marketed antiepileptic drugs (AEDs), has been approved by the FDA for treatment of seizures associated with Lennox-Gastaut syndrome (LGS) in patients ≥4 years old.
Drugs for Tobacco Dependence
The Medical Letter on Drugs and Therapeutics • September 1, 2008; (Issue 73)
Peptic ulcers caused by treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) are mainly gastric ulcers. The greater the number of office visits and the longer the counseling time, the higher the smoking...
Peptic ulcers caused by treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) are mainly gastric ulcers. The greater the number of office visits and the longer the counseling time, the higher the smoking cessation rates have been.
Drugs for Epilepsy
The Medical Letter on Drugs and Therapeutics • June 1, 2008; (Issue 70)
Treatment of epilepsy should begin with a single drug, increasing the dosage gradually until seizures are controlled or adverse effects become unacceptable. If seizures continue and further dosage increases...
Treatment of epilepsy should begin with a single drug, increasing the dosage gradually until seizures are controlled or adverse effects become unacceptable. If seizures continue and further dosage increases appear inadvisable because of adverse effects, most Medical Letter consultants generally prescribe at least one and sometimes a second alternative drug as monotherapy before considering use of two drugs at the same time. Most antiepileptic drugs initially approved by the FDA only as adjunctive therapy for partial seizures may also be effective for other types of seizures and as monotherapy. Studies suggest that when used for the appropriate seizure type, antiepileptic drugs are roughly equivalent in efficacy. The choice of a drug is usually based on factors such as ease of use, adverse effects and cost.
Diet, Drugs and Surgery for Weight Loss
The Medical Letter on Drugs and Therapeutics • April 1, 2008; (Issue 68)
Losing even a small amount of weight and increasing physical activity can prevent some of the complications of obesity, particularly type 2 diabetes. Diet and exercise are the preferred methods for losing...
Losing even a small amount of weight and increasing physical activity can prevent some of the complications of obesity, particularly type 2 diabetes. Diet and exercise are the preferred methods for losing weight but are associated with high long-term failure rates. Drugs may help some patients, but all currently available drugs for weight reduction have drawbacks. Gastric surgery can produce marked weight loss in the severely obese, but long-term data on safety are limited.
Drugs for Migraine
The Medical Letter on Drugs and Therapeutics • March 1, 2008; (Issue 67)
Some drugs for treatment of migraine attacks are listed in table 2 on page 18. Drugs for prevention of migraine are listed in table 3 on page 20. Treatment of migraine in the emergency room, which may involve...
Some drugs for treatment of migraine attacks are listed in table 2 on page 18. Drugs for prevention of migraine are listed in table 3 on page 20. Treatment of migraine in the emergency room, which may involve use of intravenous drugs, is not included here.
Drugs for Epilepsy
The Medical Letter on Drugs and Therapeutics • November 1, 2005; (Issue 39)
Treatment of epilepsy should begin with a single drug, increasing the dosage gradually until seizures are controlled or adverse effects become unacceptable. If seizures continue and further dosage increases...
Treatment of epilepsy should begin with a single drug, increasing the dosage gradually until seizures are controlled or adverse effects become unacceptable. If seizures continue and further dosage increases appear inadvisable because of adverse effects, most Medical Letter consultants generally prescribe at least one and sometimes a second alternative drug as monotherapy before considering use of two drugs at the same time. Most antiepileptic drugs initially approved by the FDA only as adjunctive therapy for partial seizures may also be effective for other types of seizures and as monotherapy.
Topiramate (Topamax) for Prevention of Migraine
The Medical Letter on Drugs and Therapeutics • January 31, 2005; (Issue 1201)
Patients with frequent, severe or disabling migraine headaches may benefit from taking a drug to prevent the attacks. Beta-blockers traditionally have been the prophylactic treatment of choice, but in recent...
Patients with frequent, severe or disabling migraine headaches may benefit from taking a drug to prevent the attacks. Beta-blockers traditionally have been the prophylactic treatment of choice, but in recent years some antiepileptic drugs such as valproate (Depakote, and others) and topiramate (Topamax) have also been used for this indication. Valproate was approved by the FDA for such use in 1996. Now topiramate has also been approved.
Acamprosate (Campral) for Alcoholism
The Medical Letter on Drugs and Therapeutics • January 3, 2005; (Issue 1199)
Acamprosate calcium (Campral - Forest) is now being marketed for oral use to maintain abstinence from alcohol. It has been used in France and other countries since...
Acamprosate calcium (Campral - Forest) is now being marketed for oral use to maintain abstinence from alcohol. It has been used in France and other countries since 1989.
Drugs for Migraine
The Medical Letter on Drugs and Therapeutics • September 1, 2004; (Issue 25)
Drugs for treatment of migraine attacks are listed in the table on page 64. All of the oral drugs are most effective if taken early in an attack when the pain is mild (H Christoph-Diener et al, Neurology 2004;...
Drugs for treatment of migraine attacks are listed in the table on page 64. All of the oral drugs are most effective if taken early in an attack when the pain is mild (H Christoph-Diener et al, Neurology 2004; 63:520). Drugs for prevention of migraine are listed in the table on page 65. Treatment of migraine in the emergency room, which may involve use of intravenous drugs, is not included here.
Drugs for Pain
The Medical Letter on Drugs and Therapeutics • July 1, 2004; (Issue 23)
Three types of analgesic drugs are available: non-opioids, including aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; opioids; and adjuvant drugs that are not usually thought of...
Three types of analgesic drugs are available: non-opioids, including aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; opioids; and adjuvant drugs that are not usually thought of as analgesics, such as antidepressants, which can act as adjuvants when given with NSAIDs or opioids, or have analgesic activity of their own in some types of pain. Combining two different types of analgesics may provide an additive analgesic effect without necessarily increasing adverse effects.
Diet, Drugs and Surgery for Weight Loss
The Medical Letter on Drugs and Therapeutics • December 1, 2003; (Issue 16)
The latest definitions of overweight and obesity are based on body mass index (BMI). The BMI is calculated by dividing the weight in kilograms by the square of the height in meters (kg/m2). More than half of...
The latest definitions of overweight and obesity are based on body mass index (BMI). The BMI is calculated by dividing the weight in kilograms by the square of the height in meters (kg/m2). More than half of American adults are considered overweight with a BMI of ≥25, and about one third are obese with a BMI of ≥30. All ages seem to be affected; the proportion of children and adolescents who are overweight has more than doubled in the past 25 years. There is no lack of effort to treat obesity: drugs, diets and programs to change lifestyle are the basis for a large and flourishing industry. The frequent failure of diet and drug treatment sometimes leads to recommendations for surgery, usually restricted to those with a BMI ≥40.
Drugs for Epilepsy
The Medical Letter on Drugs and Therapeutics • May 1, 2003; (Issue 9)
Treatment of epilepsy should begin with a single drug, increasing the dosage gradually until seizures are controlled or adverse effects become unacceptable. If seizures continue and further dosage increases...
Treatment of epilepsy should begin with a single drug, increasing the dosage gradually until seizures are controlled or adverse effects become unacceptable. If seizures continue and further dosage increases appear inadvisable because of adverse effects, most Medical Letter consultants generally prescribe at least one and sometimes a second alternative drug as monotherapy before considering use of two drugs at the same time. Most antiepileptic drugs initially approved by the FDA only for adjunctive therapy are probably also effective as monotherapy. Many of the drugs used to treat epilepsy interact with each other (see table beginning on page 63) and with other drugs; for interactions with other drugs, see The Medical Letter Handbook of Adverse Drug Interactions, 2003. The treatment of status epilepticus is not included here.
Valproate and Other Anticonvulsants For Psychiatric Disorders
The Medical Letter on Drugs and Therapeutics • December 11, 2000; (Issue 1094)
Anticonvulsants are now widely used for treatment of psychiatric illnesses, particularly bipolar disorder. Lithium is the standard drug for treatment of bipolar disorder, but it can cause severe toxicity, serum...
Anticonvulsants are now widely used for treatment of psychiatric illnesses, particularly bipolar disorder. Lithium is the standard drug for treatment of bipolar disorder, but it can cause severe toxicity, serum concentrations must be monitored, and it is not effective in some patients.
Zonisamide (Zonegran) For Epilepsy
The Medical Letter on Drugs and Therapeutics • October 2, 2000; (Issue 1089)
Zonisamide (Zonegran - Elan Pharma), a sulfonamide chemically unrelated to other antiepileptic drugs, has been approved by the FDA for adjunctive use in adults with partial seizures. Zonisamide has been...
Zonisamide (Zonegran - Elan Pharma), a sulfonamide chemically unrelated to other antiepileptic drugs, has been approved by the FDA for adjunctive use in adults with partial seizures. Zonisamide has been available in Japan for more than 10 years.
Drugs for Pain
The Medical Letter on Drugs and Therapeutics • August 21, 2000; (Issue 1085)
Three types of analgesic drugs are available: first, non-opioids, including aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; second, opioids; and third, drugs not usually thought...
Three types of analgesic drugs are available: first, non-opioids, including aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; second, opioids; and third, drugs not usually thought of as analgesics, which act as adjuvants when given with NSAIDs or opioids, or have analgesic activity of their own in some types of pain. Non-opioids can be given concurrently with opioids for an additive analgesic effect.
Two New Drugs for Epilepsy
The Medical Letter on Drugs and Therapeutics • April 17, 2000; (Issue 1076)
Oxcarbazepine, which is chemically similar to carbamazepine, and levetiracetam, a pyrrolidine acetamide chemically unrelated to other antiepileptic drugs, are the sixth and seventh drugs approved by the US Food...
Oxcarbazepine, which is chemically similar to carbamazepine, and levetiracetam, a pyrrolidine acetamide chemically unrelated to other antiepileptic drugs, are the sixth and seventh drugs approved by the US Food and Drug Administration in the last five years for oral use in partial seizures.
Topiramate for Epilepsy
The Medical Letter on Drugs and Therapeutics • May 23, 1997; (Issue 1001)
Topiramate (Topamax - Ortho-McNeil) has been approved by the US Food and Drug Administration (FDA) for oral use as an adjunct to other drugs in adult patients with partial seizures. Since this diagnostic...
Topiramate (Topamax - Ortho-McNeil) has been approved by the US Food and Drug Administration (FDA) for oral use as an adjunct to other drugs in adult patients with partial seizures. Since this diagnostic category includes the largest number of patients with refractory epilepsy, new drugs with antiepileptic activity are usually tried first for this indication. Topiramate (toe pyre' a mate) is a structurally unique agent chemically related to the D-enantiomer of fructose.