In this final installment of this series, the authors focus on the use of SSRIs in alcohol dependence, chronic pain, eating disorders, premenstrual dysphoric disorder, and sexual dysfunction. For each condition, the authors examine how well clinical trial evidence supports the application, discuss dosing and safety considerations, and provide their recommendations on preferred and alternative SSRIs, based on the weight of the evidence.
Tadalafil (Cialis) was recently deemed approvable for the treatment of erectile dysfunction (ED). When approved, it will join the widely used PDE5 inhibitor sildenafil citrate as an oral therapy for ED management. Among tadalafil?s characteristics are its rapid onset of action, a duration of action of up to 24 hours, and lack of food influence on the drug?s pharmacokinetics. In this Focus article, the pharmacologic, pharmacokinetic, and therapeutic aspects of tadalafil are reviewed and compared, when possible, with sildenafil and another investigational agent, vardenafil.
Leflunomide, etanercept, infliximab, and anakinra represent the four latest additions to the therapeutic armamentarium for rheumatoid arthritis. All four of these DMARDs have demonstrated clinical and radiographic evidence of efficacy that is changing the therapeutic approach to treatment. The authors of this article summarize the pivotal clinical trial and efficacy data up through the perimarketing period, provide the latest efficacy and safety update on these agents, discuss the financial implications of their use, and offer insights into their place in therapy.
This article reviews the efficacy of fluoroquinolones for treating community-acquired pneumonia (CAP) and discusses clinical advantages of fluoroquinolones relative to other drug classes. Of 19 randomized, controlled trials comparing a fluoroquinolone with another agent or combination of agents in CAP, 6 trials have demonstrated superiority of the fluoroquinolone with respect to clinical and/or bacteriologic efficacy.
A roundtable discussion with Vincent T. Andriole, MD, Chairperson; Paul B. Iannini, MD; Lionel A. Mandell, MD, FRCPC; Charles H. Nightingale, PhD; Lance R. Peterson, MD
The emergence of antibiotic resistance to Streptococcus pneumoniae and other bacterial pathogens is, in part, responsible for the increase in infectious-disease–related mortality occurring between 1980 and 1992.
Pharmacokinetic and pharmacodynamic parameters serve as guidelines for selecting antimicrobial agents and dose regimens that will maximize efficacy and suppress resistance.
As of January 1, 2001
Providing the information is not enough, there won't be any benefits unless the patient can understand it
State Medicaid budgets are being squeezed between soaring costs and plummeting revenues, making it difficult to cope with growing enrollment while maintaining expanded services. As budget shortfalls widen, state officials are seeking ways to curb outlays, which could mean payment cuts for providers and plans.
It might have been a fluke the first time, some healthcare insiders thought in 1996. That was the year that both Newsweek and U.S. News & World Report did their stories on the best HMOs in America, and the top-rated company was Fallon Community Health Plan, a regional mixed-model HMO with 193,000 members.
Playing it safe can reduce costs and headaches.
New formulation: Once daily administration for continuous Tx of chronic moderate-to-severe pain
New indication: Long-term, twice-daily treatment of bronchospasm associated with COPD
New indication: For delaying relapse in long-term treatment of schizophrenia
as reported May 1, 2002
Enoxaparin (Lovenox) is typically used during hospitalization after orthopedic or abdominal surgery. Recent studies of its use after orthopedic surgery have shown that extending administration of the low-molecular-weight heparin after hospital discharge significantly reduces the frequency of deep-vein thrombosis (DVT). A new study confirms this is also the case for abdominal surgery for cancer, which carries a high risk of this complication.
The investigational vasopeptidase inhibitor omapatrilat is as effective as enalapril in preventing major adverse cardiac outcomes in patients with moderate to severe heart failure, but failed to show superiority, said Milton Packer, MD.
LIPS: Statin reduces cardiac event risk by 22% in first PCI procedureAzithromax ineffective for reducing recurrent CV events
as reported May 1, 2002
Drug therapy to control heart rate is at least as effective as antiarrhythmicdrug therapy in preventing adverse clinical events in patients with atrialfibrillation (AF), according to separate studies.
Therapy starting with the angiotensin receptor blocker (ARB) losartansignificantly reduced the risk of cardiovascular outcomes and new-onsetdiabetes compared with a beta blocker in older high-risk hypertensive patients,said Björn Dahlöf, MD. The improved outcomes with losartan occurredeven after adjusting for small differences in blood pressure reduction betweenthe two study drugs.
Atlanta-The low-molecular-weight heparin enoxaparin improves outcomes compared with currently recommended therapy in patients with non-ST-segment elevation acute coronary syndromes (ACS) who are being treated with a glycoprotein (GP) IIb/IIIa inhibitor, said Shaun Goodman, MD.
Lercanidipine is currently under FDA review for the management of hypertension. In comparative clinical trials, lercanidipine has shown antihypertensive efficacy comparable to that of slow-release nifedipine, amlodipine, nitrendipine, verapamil, captopril, and atenolol. Its side effect profile is similar or superior to these agents. This Focus article reviews those trials as well as lercanidipine?s pharmacologic properties and addresses the agent?s potential role in patients with comorbid conditions.
Although selective serotonin reuptake inhibitors (SSRIs) are prescribed most often for depression disorders, they are increasingly being used to treat a variety of other conditions. In this article, the authors assess the evidence on anxiety disorders—generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, posttraumatic stress disorder, and social phobia. For each condition, they present the rationale for SSRI use, the degree of supportive clinical trial evidence, indication-specific dosing and safety considerations, and their recommendations for the preferred and alternative SSRIs.
Adding the investigational cholesterol absorption inhibitor ezetimibe to statin therapy results in additional reductions in low-density lipoprotein (LDL) cholesterol of up to 14%.
There is is a rising chorus in Washington and across the nation for action to control increased prescription drug expenditures.
The American Psychiatric Association has issued updated guidelines for the treatment of patients with bipolar disorder. The guidelines were last updated in 1994.
Last month the FDA's Nonprescription Drugs Advisory Committee unanimously supported loratadine's (Claritin, Schering-Plough) switch from prescription to over-the-counter status for treatment of chronic idiopathic urticaria, moving the drug one step closer to full OTC status (see significant event timeline in sidebar).
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