Concerns have surfaced again at the FDA and in the media about the safety of acetaminophen and the multiplicity of products on the market in the US that contain various amounts of it.

The range of drugs for treatment of chronic heart failure continues to expand. Some of those commonly used now are listed in the table on page 55. Mechanical therapies for the treatment of heart failure such as cardiac resynchronization, implanted cardiac defibrillators (ICDs), ventricular assist devices and ultrafiltration for the relief of congestion will not be reviewed here.

The nicotine receptor partial agonist varenicline (Chantix - Pfizer) appears to be the most effective drug available to treat tobacco dependence, but the FDA has added a warning to the package insert about neuropsychiatric symptoms and exacerbations of preexisting psychiatric illness associated with its use. Agitation, hostility, depressed mood, suicidal ideation and suicidal behavior have been reported as postmarketing adverse events in patients who took varenicline and stopped smoking and in those who took the drug and continued to smoke.

Lubiprostone (Amitiza), which was previously approved for treatment of chronic idiopathic constipation in adults, has now also been approved in a lower dose for use in women with irritable bowel syndrome with constipation (IBS-C). Since tegaserod (Zelnorm) has been withdrawn from the market,2 lubiprostone is the only drug approved by the FDA for treatment of this common condition.

Arformoterol tartrate (Brovana - Sepracor), a singleisomer, long-acting beta₂-agonist, has been approved by the FDA as an inhalation solution for nebulization for treatment of bronchoconstriction pulmonary disease (COPD). Arformoterol is the (R,R)-enantiomer of formoterol (Foradil), which is available as a powder for inhalation and was recently also approved as a solution for nebulization (Perforomist - Dey; available fall 2007)

Recent publicity about symptoms of ovarian cancer will prompt many questions from patients about testing for the disease. Early-stage epithelial ovarian cancer is potentially curable, with survival rates of 90-95%, but about 75% of women have advanced or metastatic disease at diagnosis. Between physical examination and exploratory surgery, 2 tests are commonly used.1

Transvaginal ultrasound (TVUS) images the ovaries better than transabdominal ultrasound. In a study in which 25,327 asymptomatic women were screened with TVUS annually from 1987 to 2005, 364 patients had exploratory surgery, and 44 had primary ovarian cancer: 28 had stage I, 8 had stage II, and 8 had stage III disease. The most common finding among those who did not have cancer was ovarian serous cystadenoma. Screening with TVUS had a sensitivity of 85.0% and a specificity of 98.7%.2

Serum concentrations of the tumor marker CA-125 are not elevated in 20-50% of women with early disease and are elevated in many noncancerous conditions, including menstruation and uterine fibroids. In one study screening 22,000 postmenopausal women, the sensitivity of serial tests in detecting ovarian cancer was 86% with a specificity of 98%; the sensitivity of a single CA-125 determination was only 62%.3 In a prospective study screening 6,537 postmenopausal women with serial CA-125 determinations, the specificity was 99.8%; only 16 women underwent surgery and 4 of them had ovarian cancer.4

A controlled trial screening for ovarian cancer with both TVUS and CA-125 measurements is underway in the UK.5 The specificity and sensitivity of either one or both of these tests in detecting early-stage ovarian cancer in women who present with symptoms remain to be established.

1. GD Aletti et al. Current management strategies for ovarian cancer. Mayo Clin Proc 2007; 82:751.

2. JR van Nagell et al. Ovarian cancer screening with annual transvaginal sonography: findings of 25,000 women screened. Cancer 2007; 109:1887.

3. SJ Skates et al. Calculation of the risk of ovarian cancer from serial CA-125 values for preclinical detection in postmenopausal women. J Clin Oncol 2003; 21 suppl 10:206s.

4. U Menon et al. Prospective study using the risk of ovarian cancer algorithm to screen for ovarian cancer. J Clin Oncol 2005; 23:7919.

5. UK collaborative trial of ovarian cancer screening. Available at www.ukctocs.org.uk. Accessed June 25, 2007.

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