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Drugs Today – March 2009


Best of the new antidepressants
A comparison of 12 new-generation antidepressants indicates that escitalopram (Lexapro) and sertraline (Zoloft) are the best choices when starting treatment for major depression. As reported in The Lancet, researchers performed a meta-analysis of 117 randomized trials with a total of almost 26,000 patients to evaluate the drugs for efficacy and patient acceptability at the 8-week mark.
Here’s what the researchers found:
•    The most efficacious drugs were escitalopram, sertraline, mirtazapine (Remeron), and venlafaxine (Effexor).
•    Escitalopram and sertraline showed the best balance between efficacy and acceptability.
•    Sertraline seemed to be less expensive than escitalopram.

Topical anesthetics can cause life-threatening effects
The Food and Drug Administration (FDA) has issued an advisory, stating that when used improperly, topical anesthetic products can cause serious adverse effects, including arrhythmias, seizures, and death. Topical anesthetics, such as lidocaine, tetracaine, benzocaine, and prilocaine, are widely used to desensitize the skin during medical and cosmetic procedures.
The problems arise when patients apply large amounts of cream, ointment, or gel without professional supervision before cosmetic procedures. The FDA warning was triggered by a number of adverse event reports, including two reports of death in women who used the drugs before undergoing laser treatment for hair removal.

No link between asthma drug and suicide risk
About a year ago, the FDA announced that it was going to review data that raised concerns about a link between montelukast (Singulair) and suicide. Recently, the FDA issued an update, indicating the drug, a leukotriene receptor antagonist that is prescribed for asthma,
isn’t tied to a higher risk of suicide. Still, the FDA intends to look into other psychiatric adverse reactions associated with the drug.

Approval for fibromyalgia drug
The FDA has approved milnacipran hydrochloride (Savella) for the management of fibromyalgia, a chronic disorder marked by extensive pain and reduced physical function. The cause of fibromyalgia, which may affect as many as six million in the United States, isn’t known.
The newly approved drug is a serotonin and norepinephrine reuptake inhibitor. During the trials, the most common adverse effects were nausea, headache, constipation, dizziness, insomnia, hot flush, hyperhidrosis, vomiting, palpations, increased heart rate, dry mouth, and hypertension. The drug is approved for adults only.

Looking into what makes clopidogrel less effective
The FDA is investigating whether the antiplatelet drug clopidogrel (Plavix) is less effective in people who have certain genetic factors and when taken with other drugs, including proton pump inhibitors (PPIs).
Studies indicate that certain polymorphisms may cause patients to metabolize clopidogrel differently. And other research shows that PPIs inhibit the enzyme that converts clopidogrel, a prodrug, to its active form, potentially rendering it less effective. Because clopidogrel can irritate the stomach, patients commonly take it with PPIs, which decrease stomach acid.
Until the FDA and the manufacturers have more information, the FDA recommends the following:
•    Healthcare providers should continue prescribing clopidogrel because of its demonstrated benefits.
•    Patients taking clopidogrel and taking or considering taking a PPI should consult their healthcare providers.
•    Healthcare providers should reevaluate the need for PPIs in patients taking clopidogrel.

Heart risks from newer antipsychotics
Researchers who examined records from the Tennessee Medicaid program found that patients taking the newer atypical antipsychotics for schizophrenia and other psychiatric disorders had double the risk of heart attack compared with nonusers.
Atypical antipsychotics include risperidone (Risperdal), quetiapine fumarate (Seroquel), and olanzapine (Zyprexa). These newer drugs were supposed to be safer than the older antipsychotics.

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