The FDA has approved the marketing of pitavastatin (Livalo – Kowa), an HMG-CoA reductase inhibitor (“statin”), for treatment of primary hyperlipidemia or mixed dyslipidemia. It has been available in Japan since 2003. All of the statins now available in the US are listed in the table on page 58.

Primary hypothyroidism is usually the result of Hashimoto's thyroiditis, thyroidectomy for hyperthyroidism, goiter or cancer, or radioactive iodine therapy for hyperthyroidism.

The thionamides propylthiouracil and methimazole are both used to treat hyperthyroidism.1 Propylthiouracil causes severe hepatic toxicity or hepatic failure in about 0.1% of adults and children.2,3 It is the third leading cause of liver transplants due to drug toxicity (acetaminophen and isoniazid are the first two). Methimazole may cause less serious hepatic toxicity; reversible cholestatic jaundice has been reported. There is generally no good reason to continue to use propylthiouracil, with 2 possible exceptions. First, propylthiouracil may be preferred for treatment of life-threatening thyroid storm because it inhibits conversion of T4 to T3, while methimazole does not. Second, propylthiouracil may be preferable for use in pregnancy because use of methimazole has rarely been associated with aplasia cutis and with choanal and esophageal atresia.

1. Drugs for thyroid disorders. Treat Guidel Med Lett 2009; 7:57.
2. SA Rivkees and DR Mattison. Ending propylthiouracil-induced liver failure in children. N Engl J Med 2009; 360:1574.
3. DS Cooper and SA Rivkees. Putting propylthiouracil in perspective. J Clin Endocrinol Metab 2009; 94:1881.

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The FDA has approved benzyl alcohol lotion, 5% (Ulesfia Lotion - Sciele) for treatment of head lice in patients ≥6 months old. The active ingredient is 5% benzyl alcohol; the vehicle is 5% mineral oil.

Duloxetine (Cymbalta - Lilly) is the second drug to be approved by the FDA for treatment of fibromyalgia. Pregabalin (Lyrica), which is also approved for treatment of neuropathic pain and epilepsy, was the first. Duloxetine is a selective serotonin and norepinephrine reuptake inhibitor (SNRI) that is already marketed for treatment of depression and diabetic neuropathy.

The U.S. Advisory Committee on Immunization Practices has recommended administration of the quadrivalent conjugated polysaccharide meningococcal vaccine (Menactra – Sanofi Pasteur) to all persons 11 to 18 years old, particularly those entering high school and college freshmen living in dormitories.1,2 The peak incidence of meningococcal disease, after early childhood, occurs in the 15-19 year-old age group. The conjugate vaccine is more immunogenic than the meningococcal capsular polysaccharide vaccine (Menommune – Sanofi Pasteur).

ADVERSE EFFECTS — The most common adverse reactions with the conjugate vaccine have been headache, fatigue and malaise, in addition to pain, redness and induration at the injection site. Guillain-Barré syndrome has occurred rarely.3

CONCLUSION — Previously unvaccinated children starting high school or going away to college this fall should receive a single dose of meningococcal conjugate vaccine (Menactra).

1. Centers for Disease Control and Prevention (CDC). Advisory Committee on Immunization Practices. Revised recommendations of the Advisory Committee on Immunization Practices to vaccinate all persons aged 11-18 years with meningococcal conjugate vaccine. MMWR Morb Mortal Wkly Rep 2007; 56:794.
2. Menactra: a meningococcal conjugate vaccine. Med Lett Drugs Ther 2005; 47:29.
3. Centers for Disease Control and Prevention (CDC). Update: Guillain-Barre syndrome among recipients of Menactra meningococcal conjugate vaccine — United States, October 2005-February 2006. MMWR Morb Mortal Wkly Rep 2006; 55:364.

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The thiazolidinediones rosiglitazone (Avandia) and pioglitazone (Actos) are peripheral insulin sensitizing agents used to treat hyperglycemia in patients with type 2 diabetes; one or the other is often used as a second or third agent with metformin (Glucophage, and others) and/or a sulfonylurea such as glimepiride (Amaryl, and others). A recent report suggested that rosiglitazone may increase the incidence of myocardial infarction (MI) and cardiovascular mortality.