Formulary Watch |

Ramelteon: A novel melatonin receptor agonist for the treatment of insomnia

Ramelteon (Takeda Pharmaceuticals) is a selective melatonin receptor agonist awaiting FDA approval for the treatment of insomnia. Unlike the currently prescribed hypnotic agents that work by targeting gamma-aminobutyric acid (GABA) receptors, ramelteon offers a novel mechanism of action, specifically targeting the MT1 and MT2 receptors in the brain, which are thought to play a role in regulating sedation and circadian rhythms. Ramelteon is characterized by undergoing extensive first-pass metabolism along with having high oral bioavailability. Results of phase 2 clinical trials have demonstrated that ramelteon-treated patients had significantly shorter sleep onset latencies and longer total sleep times than placebo-treated patients. Furthermore, ramelteon therapy did not appear to impair patient cognition, memory recall, levels of alertness, or ability to concentrate. Data from animal studies suggest that ramelteon is not likely to cause abuse or physical dependence. Unlike the current FDA-approved..

First-time generic approvals

Anti-sense compound (LR3001, Genta) for the treatment of chronic myelocytic leukemia

Hyzaar

Combination indicated to reduce risk of stroke in hypertensive patients with LVH

Boniva

First once-monthly therapy approved for treatment and prevention of osteoporosis

Drug Watch: Agents in late-stage development for the treatment of HIV/AIDS (April 2005) (PDF)

A review of agents in late-stage development for the treatment of HIV/AIDS (April 2005).

Drug Watch: Agents in late-stage development for the treatment of HIV/AIDS (April 2005) (PDF)

A review of agents in late-stage development for the treatment of HIV/AIDS (April 2005).

Aspirin plus esomeprazole superior to clopidogrel for prevention of recurrent ulcer bleeding

Among patients with a history of aspirin-induced ulcer bleeding, aspirin plus esomeprazole was shown to be superior to clopidogrel for the prevention of recurrent bleeding. The results of a 12-month, prospective, randomized, double-blind trial do not support current American College of Cardiology/American Heart Association guidelines recommending that clopidogrel be used as an alternative antiplatelet agent in patients who have a major gastrointestinal intolerance to aspirin, according to the authors of the study.

Tipranavir

If approved, tipranavir (Boehringer Ingelheim) will be the ninth protease inhibitor (PI) available and the first nonpeptidic PI available in the United States. Designed by structure-based analysis, tipranavir is more flexible at the binding site, allowing for a potent and durable antiretroviral response. The tipranavir (TPV) and ritonavir (RTV) PI regimen (TPV/r) studied in clinical trials had a moderate pill burden, requiring 4 pills to be taken twice daily (2 RTV 100 mg and 2 TPV 250 mg).

FDA actions in brief

Peginterferon alfa-2a (Pegasys, Roche) and ribavirin (Copegus, Roche) were approved in combination for the treatment of chronic hepatitis C in patients coinfected with HIV who have clinically stable HIV disease.

A timely transition to insulin: Identifying type 2 diabetes patients failing oral therapy

Although oral antidiabetic medications initially may be effective for controlling hyperglycemia, these agents often fail to maintain adequate glycemic control as the disease progresses, and insulin eventually is required in most patients. This review explores strategies for identifying patients with type 2 diabetes who are failing to maintain glycemic control on oral agents and for transitioning these patients to insulin. Based on available data, patients are not reaching recommended glycemic goals due to delays in and reluctance towards intensification of therapy, resulting in an increased risk of complications.

Symlin

This novel echinocandin antifungal exerts its antibiotic activity by inhibiting the synthesis of 1,3-?-D-glucan, an essential component of fungal cell walls.

Mycamine

This novel echinocandin antifungal exerts its antibiotic activity by inhibiting the synthesis of 1,3-β-D-glucan, an essential component of fungal cell walls.

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Ziprasidone and risperidone equally efficacious for treatment of acute exacerbation of schizophrenia or schizoaffective disorder

Ziprasidone (Geodon, Pfizer) and risperidone (Risperdal, Janssen) are equally efficacious in the treatment of patients with acute exacerbation of schizophrenia and schizoaffective disorder, with ziprasidone demonstrating a lower movement disorder burden and less effect on prolactin concentrations and weight than risperidone.

Drug Watch: Agents in late-stage development for the treatment of osteoporosis (March 2005) (PDF)

A review of agents in late-stage development for the treatment of osteoporosis (March 2005)

Exenatide: A novel incretin mimetic hormone for the treatment of type 2 diabetes

A number of clinical approaches are utilized in managing the overlapping aspects of poor glycemic control in patients with type 2 diabetes. Exenatide (Amylin/Lilly), a novel drug in a new medication class known as the incretin mimetic agents, offers a new mechanism to achieve glycemic control.

FDA actions in brief

A new dosage strength of the fentanyl transdermal system (Duragesic, Alza) was approved for the management of persistent, moderate-to-severe chronic pain requiring continuous opioid administration for an extended period of time that cannot be managed by other drugs. The new patch will deliver 12 mcg of fentanyl per hour.

Cardiac death risk 5x greater with concurrent oral erythromycin and CYP3A inhibitors

Concurrent use of oral erythromycin and strong inhibitors of CYP3A should be avoided, according to research published in The New England Journal of Medicine.

FDA advisory committees recommend marketing of COX-2 inhibitors with 'black box' warning

Despite unanimity in the belief that the COX-2 selective nonsteroidal anti-inflammatory drugs (NSAIDs) significantly increase cardiovascular risk, FDA's Arthritis and Drug Safety and Risk Management Advisory Committees have advised FDA that the risk/benefit profile of the previously approved COX-2 inhibitors support the marketing of these agents in the United States.

Crawford nominated for permanent FDA commissioner role

President George W. Bush recently nominated Lester M. Crawford, DVM, PhD, to take the permanent role of FDA commissioner after serving as acting or deputy administrator since February 2002.

Prior lack of efficacy with etanercept does not predict lack of efficacy with infliximab

A study conducted by researchers at the University of Wisconsin, Stanford University, and several rheumatology clinics across the United States found that rheumatoid arthritis (RA) patients who do not receive sufficient benefit with etanercept may experience improved disease control by switching to infliximab.

Ziprasidone and risperidone equally efficacious for treatment of acute exacerbation of schizophrenia or schizoaffective disorder

Ziprasidone (Geodon, Pfizer) and risperidone (Risperdal, Janssen) are equally efficacious in the treatment of patients with acute exacerbation of schizophrenia and schizoaffective disorder, with ziprasidone demonstrating a lower movement disorder burden and less effect on prolactin concentrations and weight than risperidone.

ACE inhibitors that penetrate the blood-brain barrier may slow Alzheimer's progress

Researchers have found that angiotensin-converting enzyme (ACE) inhibitors that penetrate the blood-brain barrier (BBB) appear to reduce the incidence of Alzheimer's disease (AD) in elderly patients with hypertension.

ACE inhibitors reduce all-cause mortality in diabetic nephropathy; data unclear for AIIRAs

A meta-analysis demonstrates that angiotensin converting enzyme (ACE) inhibitors provide a survival benefit in patients with diabetic nephropathy, whereas no such evidence exists for angiotensin II receptor antagonists (AIIRAs).

Exenatide: A novel incretin mimetic hormone for the treatment of type 2 diabetes

A number of clinical approaches are utilized in managing the overlapping aspects of poor glycemic control in patients with type 2 diabetes. Exenatide (Amylin/Lilly), a novel drug in a new medication class known as the incretin mimetic agents, offers a new mechanism to achieve glycemic control.

The use of virtual expert panels: formulary decision-making in the 21st century

Evidence-based medicine is the driving philosophy for pharmacy and therapeutics (P&T) committee decision-making. When the available evidence is incomplete or unclear, the decision-making process becomes complex. Evaluation of the published literature to make sound decisions regarding appropriate medication use can be a time-consuming process. The use of expert panels or subcommittees may facilitate decision-making; however, this process is often limited by the schedules and time constraints of busy clinicians. This article describes the creation and utilization of a "virtual" panel of experts utilizing anonymous electronic communications to assist the P&T committee at a university-based teaching hospital in making medication use policy. The article includes a detailed description of the P&T committee's experience in the selection of virtual panel members, methods used, advantages, potential pitfalls, and the outcomes of a virtual committee used to evaluate the appropriateness of the off-label use of nesiritide (Natrecor, Scios).

Pipeline preview

Surfactant replacement therapy (Surfaxin, Discovery Laboratories) for the prevention of respiratory distress syndrome (RDS) in premature infants

First-time generic approvals

Potassium iodide oral solution 65 mg/mL

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New molecular entities: Lunesta

First prescription sleep aid not limited to short-term use