Matching articles for "gabapentin"
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.
Drugs for Menopausal Symptoms
The Medical Letter on Drugs and Therapeutics • March 4, 2024; (Issue 1697)
The primary symptoms of menopause are genitourinary
and vasomotor. The genitourinary syndrome
of menopause (GSM) includes symptoms such as
burning, irritation, dryness, dyspareunia, dysuria,
and recurrent...
The primary symptoms of menopause are genitourinary
and vasomotor. The genitourinary syndrome
of menopause (GSM) includes symptoms such as
burning, irritation, dryness, dyspareunia, dysuria,
and recurrent urinary tract infection. Vasomotor
symptoms (VMS; hot flashes, night sweats) often
disrupt sleep.
Addendum: Gabapentinoids and Renal Impairment
The Medical Letter on Drugs and Therapeutics • October 2, 2023; (Issue 1686)
A nephrologist and longtime reader of The Medical Letter
wrote us to say that our recent article entitled Drugs for
Anxiety Disorders should have said more about the need
for dosage adjustment of gabapentin...
A nephrologist and longtime reader of The Medical Letter
wrote us to say that our recent article entitled Drugs for
Anxiety Disorders should have said more about the need
for dosage adjustment of gabapentin (Neurontin, and
others) and pregabalin (Lyrica, and others) in patients
with renal impairment. Both drugs, he pointed out, are
exclusively renally eliminated and can accumulate in
patients with diminished renal function. Symptoms,
which can include altered mental status, may develop
so slowly that neither the patient nor the practitioner
connect them to the drug. The resolution of adverse
effects upon discontinuation can be slow.
Drugs for Anxiety Disorders
The Medical Letter on Drugs and Therapeutics • August 7, 2023; (Issue 1682)
Anxiety disorders (generalized anxiety disorder,
panic disorder, social anxiety disorder, and various
phobias) are the most common form of psychiatric
illness. They can be treated effectively with...
Anxiety disorders (generalized anxiety disorder,
panic disorder, social anxiety disorder, and various
phobias) are the most common form of psychiatric
illness. They can be treated effectively with cognitive
behavioral therapy (CBT) and/or pharmacotherapy.
Fezolinetant (Veozah) for Menopausal Vasomotor Symptoms
The Medical Letter on Drugs and Therapeutics • June 26, 2023; (Issue 1679)
Fezolinetant (Veozah – Astellas), a first-in-class
neurokinin 3 (NK3) receptor antagonist, has been
approved by the FDA for treatment of moderate to
severe vasomotor symptoms (VMS) due to menopause.
It is...
Fezolinetant (Veozah – Astellas), a first-in-class
neurokinin 3 (NK3) receptor antagonist, has been
approved by the FDA for treatment of moderate to
severe vasomotor symptoms (VMS) due to menopause.
It is the second nonhormonal treatment to be approved
in the US for this indication; a low-dose formulation of
the selective serotonin reuptake inhibitor (SSRI)
paroxetine mesylate (Brisdelle) was approved in 2013.
Drugs for Chronic Insomnia
The Medical Letter on Drugs and Therapeutics • January 9, 2023; (Issue 1667)
Cognitive behavioral therapy for insomnia (CBT-I) is
recommended for initial treatment of chronic insomnia.
CBT-I includes stimulus control, sleep education
and hygiene, sleep restriction, relaxation...
Cognitive behavioral therapy for insomnia (CBT-I) is
recommended for initial treatment of chronic insomnia.
CBT-I includes stimulus control, sleep education
and hygiene, sleep restriction, relaxation training, and
cognitive therapy. When CBT-I alone is not effective,
pharmacologic treatment should be added.
Nonopioid Drugs for Pain
The Medical Letter on Drugs and Therapeutics • March 7, 2022; (Issue 1645)
Nonopioid drugs can be used in the treatment of
many nociceptive and neuropathic pain conditions.
For severe pain, especially severe chronic cancer
pain, use of opioids may be necessary....
Nonopioid drugs can be used in the treatment of
many nociceptive and neuropathic pain conditions.
For severe pain, especially severe chronic cancer
pain, use of opioids may be necessary. Noninvasive
nonpharmacologic treatments, including physical
and psychological therapies, have been shown to
improve pain and function in patients with some
common chronic pain conditions and are unlikely
to cause serious harms. A multimodal approach to
analgesic therapy can increase pain control while
reducing opioid use and adverse effects.
Difelikefalin (Korsuva) for Chronic Kidney Disease-Associated Pruritus
The Medical Letter on Drugs and Therapeutics • February 7, 2022; (Issue 1643)
Difelikefalin (Korsuva – Vifor), an IV kappa opioid
receptor (KOR) agonist, has been approved by the
FDA for treatment of moderate to severe pruritus
associated with chronic kidney disease (CKD) in
adults...
Difelikefalin (Korsuva – Vifor), an IV kappa opioid
receptor (KOR) agonist, has been approved by the
FDA for treatment of moderate to severe pruritus
associated with chronic kidney disease (CKD) in
adults on hemodialysis. It is the first drug to be
approved for this indication and the first KOR agonist
to become available in the US. Difelikefalin has not
been studied in patients on peritoneal dialysis.
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.
Drugs for Menopausal Symptoms
The Medical Letter on Drugs and Therapeutics • August 10, 2020; (Issue 1604)
The primary symptoms of menopause are genitourinary
(genitourinary syndrome of menopause; GSM) and
vasomotor (VMS). Vulvovaginal atrophy can cause
vaginal burning, irritation and dryness, dyspareunia,...
The primary symptoms of menopause are genitourinary
(genitourinary syndrome of menopause; GSM) and
vasomotor (VMS). Vulvovaginal atrophy can cause
vaginal burning, irritation and dryness, dyspareunia, and
dysuria, and increase the risk of urinary tract infections.
Vasomotor symptoms ("hot flashes") cause daytime
discomfort and night sweats that may disrupt sleep.
Hormone therapy is the most effective treatment for both
genitourinary and vasomotor symptoms.
In Brief: Respiratory Depression with Gabapentinoids
The Medical Letter on Drugs and Therapeutics • June 1, 2020; (Issue 1599)
The FDA has required new warnings in the labels of
gabapentin (Neurontin, and others) and pregabalin (Lyrica,
Lyrica CR, and generics) about the risk of life-threatening or
fatal respiratory depression in...
The FDA has required new warnings in the labels of
gabapentin (Neurontin, and others) and pregabalin (Lyrica,
Lyrica CR, and generics) about the risk of life-threatening or
fatal respiratory depression in patients with respiratory risk
factors. Respiratory risk factors include chronic obstructive
pulmonary disease (COPD) and concurrent use of opioids
or other CNS depressants. Elderly patients are also at
increased risk.
Drugs for Anxiety Disorders
The Medical Letter on Drugs and Therapeutics • August 12, 2019; (Issue 1578)
Anxiety disorders (generalized anxiety disorder, panic
disorder, social anxiety disorder, and various phobias)
are the most common form of psychiatric illness. They
can be treated effectively with cognitive...
Anxiety disorders (generalized anxiety disorder, panic
disorder, social anxiety disorder, and various phobias)
are the most common form of psychiatric illness. They
can be treated effectively with cognitive behavioral
therapy (CBT) and/or pharmacotherapy. Obsessive-compulsive
disorder and posttraumatic stress
disorder are now considered separate entities in the
Diagnostic and Statistical Manual of Mental Disorders
(DSM-5); they can also be treated with CBT and many
of the same drugs.
ZTlido - A New Lidocaine Patch for Postherpetic Neuralgia
The Medical Letter on Drugs and Therapeutics • March 25, 2019; (Issue 1568)
A lidocaine 1.8% patch (ZTlido – Scilex) has been
approved by the FDA for treatment of pain associated
with postherpetic neuralgia (PHN). A lidocaine 5%
patch (Lidoderm, and generics) was approved...
A lidocaine 1.8% patch (ZTlido – Scilex) has been
approved by the FDA for treatment of pain associated
with postherpetic neuralgia (PHN). A lidocaine 5%
patch (Lidoderm, and generics) was approved earlier
for the same indication and has been used off-label
for treatment of other types of localized pain. Both
of these patches are available only by prescription.
Lidocaine 4% patches (Aspercreme, IcyHot, and others)
are available over the counter for back, neck, shoulder,
and joint pain.
Oxybutynin for Hot Flashes in Women with Breast Cancer
The Medical Letter on Drugs and Therapeutics • February 25, 2019; (Issue 1566)
Interim results of a double-blind, placebo-controlled
trial suggest that off-label use of the anticholinergic
drug oxybutynin may reduce the frequency and
severity of hot flashes in women with breast...
Interim results of a double-blind, placebo-controlled
trial suggest that off-label use of the anticholinergic
drug oxybutynin may reduce the frequency and
severity of hot flashes in women with breast cancer.
Extended-release oral oxybutynin (Ditropan XL, and
generics) has been shown to reduce the frequency and
severity of hot flashes in healthy menopausal women.
Drugs for Chronic Insomnia
The Medical Letter on Drugs and Therapeutics • December 17, 2018; (Issue 1562)
Cognitive behavioral therapy for insomnia (CBT-I)
is recommended for initial treatment of chronic
insomnia. Pharmacologic treatment should be used in
addition to CBT-I when CBT-I alone is not...
Cognitive behavioral therapy for insomnia (CBT-I)
is recommended for initial treatment of chronic
insomnia. Pharmacologic treatment should be used in
addition to CBT-I when CBT-I alone is not effective.
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 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
Drugs for Insomnia
The Medical Letter on Drugs and Therapeutics • July 6, 2015; (Issue 1472)
Pharmacological treatment of insomnia includes
prescription drugs, non-prescription medications, and
"natural" remedies. Behavioral approaches such as
cognitive behavioral therapy, which are not...
Pharmacological treatment of insomnia includes
prescription drugs, non-prescription medications, and
"natural" remedies. Behavioral approaches such as
cognitive behavioral therapy, which are not discussed
here, are also used. Pharmacologic treatment and
behavioral therapy are often combined.
Drugs for Pain
The Medical Letter on Drugs and Therapeutics • April 1, 2013; (Issue 128)
Pain can be acute or chronic. The two major types of
chronic pain are nociceptive pain and neuropathic
pain. Nociceptive pain can be treated with nonopioid
analgesics or opioids. Neuropathic pain is less...
Pain can be acute or chronic. The two major types of
chronic pain are nociceptive pain and neuropathic
pain. Nociceptive pain can be treated with nonopioid
analgesics or opioids. Neuropathic pain is less responsive
to opioids and is often treated with adjuvant drugs
such as antidepressants and antiepileptics. Combining
different types of analgesics may provide an additive
analgesic effect without increasing adverse effects.
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.
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).
Drugs for Insomnia
The Medical Letter on Drugs and Therapeutics • July 1, 2012; (Issue 119)
Pharmacological treatment of insomnia includes prescription
drugs, non-prescription medications and
"natural" remedies. Behavioral changes are often
needed as...
Pharmacological treatment of insomnia includes prescription
drugs, non-prescription medications and
"natural" remedies. Behavioral changes are often
needed as well.
Drugs for Menopausal Symptoms
The Medical Letter on Drugs and Therapeutics • May 28, 2012; (Issue 1391)
The primary symptoms of menopause are vasomotor
and genitourinary. Vasomotor symptoms ("hot flashes")
cause daytime discomfort and chronic insomnia. A thin,
dry vaginal lining and thin urethral mucosa can...
The primary symptoms of menopause are vasomotor
and genitourinary. Vasomotor symptoms ("hot flashes")
cause daytime discomfort and chronic insomnia. A thin,
dry vaginal lining and thin urethral mucosa can cause
vaginal and vulvar irritation, pain during intercourse, and
an increased risk for urinary tract infection.
Once-Daily Gabapentin (Gralise) for Postherpetic Neuralgia
The Medical Letter on Drugs and Therapeutics • November 28, 2011; (Issue 1378)
A new once-daily formulation of gabapentin (Gralise –
Depomed) has been approved by the FDA for treatment
of postherpetic neuralgia (PHN). Immediate-release
(IR) gabapentin (Neurontin, and others),...
A new once-daily formulation of gabapentin (Gralise –
Depomed) has been approved by the FDA for treatment
of postherpetic neuralgia (PHN). Immediate-release
(IR) gabapentin (Neurontin, and others), which
has been available in the US since 1994, is also
approved for this indication, but is taken three times a
day. Extended-release gabapentin enacarbil (Horizant)
was recently approved by the FDA for treatment of restless
legs syndrome.
Gabapentin Enacarbil (Horizant) for Restless Legs Syndrome
The Medical Letter on Drugs and Therapeutics • September 5, 2011; (Issue 1372)
Gabapentin enacarbil (Horizant – GlaxoSmithKline), a
new extended-release (ER) tablet formulation of
gabapentin, has been approved by the FDA for treatment
of moderate-to-severe restless legs...
Gabapentin enacarbil (Horizant – GlaxoSmithKline), a
new extended-release (ER) tablet formulation of
gabapentin, has been approved by the FDA for treatment
of moderate-to-severe restless legs syndrome
(RLS). The immediate-release (IR) formulation of
gabapentin (Neurontin,and others), which is approved for treatment of epilepsy and postherpetic neuralgia,
has been used for many years to treat RLS. Another
ER tablet formulation of gabapentin (Gralise) has been
approved by the FDA for treatment of postherpetic
neuralgia.
Capsaicin Patch (Qutenza) for Postherpetic Neuralgia
The Medical Letter on Drugs and Therapeutics • May 30, 2011; (Issue 1365)
The FDA has approved a topical 8% patch formulation
of capsaicin (Qutenza – NeurogesX), available only by
prescription, for local treatment of postherpetic neuralgia.
Postherpetic neuralgia occurs after...
The FDA has approved a topical 8% patch formulation
of capsaicin (Qutenza – NeurogesX), available only by
prescription, for local treatment of postherpetic neuralgia.
Postherpetic neuralgia occurs after herpes zoster
in about one third of patients ≥60 years old and can
persist for months or even years.
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.
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.
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.
Drugs That May Cause Psychiatric Symptoms
The Medical Letter on Drugs and Therapeutics • December 15, 2008; (Issue 1301)
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...
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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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.
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.
Pregabalin (Lyrica) for Fibromyalgia
The Medical Letter on Drugs and Therapeutics • September 24, 2007; (Issue 1270)
Pregabalin (Lyrica - Pfizer) is the first drug approved by the FDA for management of fibromyalgia. When it was first marketed, pregabalin, which is structurally similar to gabapentin (Neurontin, and others),...
Pregabalin (Lyrica - Pfizer) is the first drug approved by the FDA for management of fibromyalgia. When it was first marketed, pregabalin, which is structurally similar to gabapentin (Neurontin, and others), was approved for treatment of neuropathic pain associated with postherpetic neuralgia and diabetic peripheral neuropathy and for adjunctive treatment of partial onset seizures in adults with epilepsy. It has also been prescribed off-label for other types of neuropathic pain such as sciatica.
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.
Pregabalin (Lyrica) for Neuropathic Pain and Epilepsy
The Medical Letter on Drugs and Therapeutics • September 12, 2005; (Issue 1217)
Pregabalin (Lyrica - Pfizer), a structural analog of gamma-aminobutyric acid (GABA) similar to gabapentin (Neurontin - Pfizer, and others), which recently became available generically, has been approved by the...
Pregabalin (Lyrica - Pfizer), a structural analog of gamma-aminobutyric acid (GABA) similar to gabapentin (Neurontin - Pfizer, and others), which recently became available generically, has been approved by the FDA for treatment of neuropathic pain associated with postherpetic neuralgia (PHN) and diabetic peripheral neuropathy (DPN), and for adjunctive treatment of partial onset seizures in adults with epilepsy.
Duloxetine (Cymbalta) for Diabetic Neuropathic Pain
The Medical Letter on Drugs and Therapeutics • August 15, 2005; (Issue 1215)
Duloxetine hydrochloride (Cymbalta - Lilly), a selective serotonin and norepinephrine reuptake inhibitor (SNRI) available for treatment of depression, has also been approved by the FDA for treatment of...
Duloxetine hydrochloride (Cymbalta - Lilly), a selective serotonin and norepinephrine reuptake inhibitor (SNRI) available for treatment of depression, has also been approved by the FDA for treatment of neuropathic pain associated with diabetic peripheral neuropathy (DPN). Duloxetine is one of two drugs approved specifically for management of neuropathic pain due to diabetes; the other, pregabalin (Lyrica - Pfizer), will be marketed soon and will be reviewed in the next issue of The Medical Letter.
Ropinirole for Restless Legs Syndrome
The Medical Letter on Drugs and Therapeutics • August 1, 2005; (Issue 1214)
Ropinirole (Requip - GlaxoSmithKline), a dopamine agonist already available for treatment of Parkinson's disease, is now the first drug approved by the FDA for treatment of moderate to severe restless legs...
Ropinirole (Requip - GlaxoSmithKline), a dopamine agonist already available for treatment of Parkinson's disease, is now the first drug approved by the FDA for treatment of moderate to severe restless legs syndrome (RLS).
Treatment of Menopausal Vasomotor Symptoms
The Medical Letter on Drugs and Therapeutics • December 6, 2004; (Issue 1197)
Estrogen is the most effective treatment for menopausal vasomotor symptoms (hot flashes), but the Women's Health Initiative study found that women who took estrogen plus a progestin for more than 5 years were...
Estrogen is the most effective treatment for menopausal vasomotor symptoms (hot flashes), but the Women's Health Initiative study found that women who took estrogen plus a progestin for more than 5 years were at increased risk for myocardial infarction, stroke, pulmonary emboli, deep vein thrombosis, breast cancer, and possibly dementia. Are there effective alternatives?
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.
Gabapentin (Neurontin) for Chronic Pain
The Medical Letter on Drugs and Therapeutics • April 12, 2004; (Issue 1180)
Gabapentin (Neurontin - Pfizer), which has been available in the US since 1994, is approved by the FDA only for treatment of partial epilepsy and postherpetic neuralgia, but is widely used off-label for a...
Gabapentin (Neurontin - Pfizer), which has been available in the US since 1994, is approved by the FDA only for treatment of partial epilepsy and postherpetic neuralgia, but is widely used off-label for a number of other indications, especially neuropathic pain syndromes. According to one report, among Medicaid recipients in Florida receiving gabapentin, 71% of prescriptions were for chronic pain and 8% for seizures and neuralgia ("The Pink Sheet" February 2, 2004; 66:30).
Drugs for Psychiatric Disorders
The Medical Letter on Drugs and Therapeutics • July 1, 2003; (Issue 11)
The number of drugs marketed for psychiatric indications has increased sharply in recent years. The recommendations in this article are based on the results of controlled trials and on the experience and...
The number of drugs marketed for psychiatric indications has increased sharply in recent years. The recommendations in this article are based on the results of controlled trials and on the experience and opinions of Medical Letter consultants. Interactions with other drugs can be found in The Medical Letter Handbook of Adverse Drug Interactions, 2003.
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.
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.
Drugs for Pain
The Medical Letter on Drugs and Therapeutics • August 14, 1998; (Issue 1033)
Three types of analgesic drugs are available: first, non-opioids, including aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; second, opioids; and third, some drugs not usually...
Three types of analgesic drugs are available: first, non-opioids, including aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; second, opioids; and third, some 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.
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.
Lamotrigine For Epilepsy
The Medical Letter on Drugs and Therapeutics • March 17, 1995; (Issue 944)
Lamotrigine (la mo tri jeen; Lamictal - Burroughs Wellcome), a phenyltriazine derivative, has been approved by the US Food and Drug Administration for use in addition to other antiepileptic drugs in adults...
Lamotrigine (la mo tri jeen; Lamictal - Burroughs Wellcome), a phenyltriazine derivative, has been approved by the US Food and Drug Administration for use in addition to other antiepileptic drugs in adults with partial seizures. Since this diagnostic category includes the largest number of patients with intractable epilepsy, new drugs with antiepileptic activity are usually tried first for this indication. Lamotrigine was first marketed abroad in 1990 and is now available in more than 50 other countries.