Matching articles for "amitriptyline"
Drugs for Depression
The Medical Letter on Drugs and Therapeutics • December 11, 2023; (Issue 1691)
A selective serotonin reuptake inhibitor (SSRI) is
generally used for initial treatment of major depressive
disorder (MDD). A serotonin-norepinephrine reuptake
inhibitor (SNRI), bupropion (Wellbutrin SR,...
A selective serotonin reuptake inhibitor (SSRI) is
generally used for initial treatment of major depressive
disorder (MDD). A serotonin-norepinephrine reuptake
inhibitor (SNRI), bupropion (Wellbutrin SR, and
others), and mirtazapine (Remeron, and others) are
reasonable alternatives. Improvement in symptoms
can occur within the first two weeks of treatment
with these drugs, but a substantial benefit may not be
achieved for 4-8 weeks.
Comparison Table: Some Drugs for Migraine Prevention in Adults (online only)
The Medical Letter on Drugs and Therapeutics • June 12, 2023; (Issue 1678)
...
View the Comparison Table: Some Drugs for Migraine Prevention in Adults
Drugs for Migraine
The Medical Letter on Drugs and Therapeutics • June 12, 2023; (Issue 1678)
An oral nonopioid analgesic is often sufficient for
acute treatment of mild to moderate migraine pain
without severe nausea or vomiting. A triptan is the
drug of choice for treatment of moderate to...
An oral nonopioid analgesic is often sufficient for
acute treatment of mild to moderate migraine pain
without severe nausea or vomiting. A triptan is the
drug of choice for treatment of moderate to severe
migraine in most patients without vascular disease.
Treatment of pain when it is still mild to moderate in
intensity improves headache response and reduces
the risk of recurrence.
In Brief: Off-Label Amitriptyline for Insomnia
The Medical Letter on Drugs and Therapeutics • March 20, 2023; (Issue 1672)
In our article on Drugs for Chronic Insomnia, we said
there is little evidence that antidepressants such as
trazodone, mirtazapine, or amitriptyline are effective
in treating insomnia not associated with...
In our article on Drugs for Chronic Insomnia, we said
there is little evidence that antidepressants such as
trazodone, mirtazapine, or amitriptyline are effective
in treating insomnia not associated with depression.
We received a comment from a reader who has
prescribed the tricyclic antidepressant amitriptyline
for insomnia, particularly for patients with headache
disorders, and finds that most patients are satisfied
with the treatment.
Drugs for Chronic Insomnia
The Medical Letter on Drugs and Therapeutics • January 9, 2023; (Issue 1667)
Cognitive behavioral therapy for insomnia (CBT-I) is
recommended for initial treatment of chronic insomnia.
CBT-I includes stimulus control, sleep education
and hygiene, sleep restriction, relaxation...
Cognitive behavioral therapy for insomnia (CBT-I) is
recommended for initial treatment of chronic insomnia.
CBT-I includes stimulus control, sleep education
and hygiene, sleep restriction, relaxation training, and
cognitive therapy. When CBT-I alone is not effective,
pharmacologic treatment should be added.
Nonopioid Drugs for Pain
The Medical Letter on Drugs and Therapeutics • March 7, 2022; (Issue 1645)
Nonopioid drugs can be used in the treatment of
many nociceptive and neuropathic pain conditions.
For severe pain, especially severe chronic cancer
pain, use of opioids may be necessary....
Nonopioid drugs can be used in the treatment of
many nociceptive and neuropathic pain conditions.
For severe pain, especially severe chronic cancer
pain, use of opioids may be necessary. Noninvasive
nonpharmacologic treatments, including physical
and psychological therapies, have been shown to
improve pain and function in patients with some
common chronic pain conditions and are unlikely
to cause serious harms. A multimodal approach to
analgesic therapy can increase pain control while
reducing opioid use and adverse effects.
Drugs for Migraine
The Medical Letter on Drugs and Therapeutics • October 5, 2020; (Issue 1608)
An oral nonopioid analgesic is often sufficient for acute
treatment of mild to moderate migraine headache
without severe nausea or vomiting. A triptan is the
drug of choice for treatment of moderate to...
An oral nonopioid analgesic is often sufficient for acute
treatment of mild to moderate migraine headache
without severe nausea or vomiting. A triptan is the
drug of choice for treatment of moderate to severe
migraine headache pain in most patients without
vascular disease. Early treatment of pain when it is
still mild to moderate in intensity improves headache
response and reduces the risk of recurrence.
Eptinezumab (Vyepti) for Migraine Prevention
The Medical Letter on Drugs and Therapeutics • June 1, 2020; (Issue 1599)
The FDA has approved eptinezumab-jjmr (Vyepti –
Lundbeck), a calcitonin gene-related peptide (CGRP)
antagonist administered IV once every 3 months, for
migraine prevention in adults. It is the fourth...
The FDA has approved eptinezumab-jjmr (Vyepti –
Lundbeck), a calcitonin gene-related peptide (CGRP)
antagonist administered IV once every 3 months, for
migraine prevention in adults. It is the fourth monoclonal
antibody to be approved for this indication; erenumab
(Aimovig), fremanezumab (Ajovy), and galcanezumab
(Emgality), which are all given subcutaneously once
monthly (fremanezumab can also be given once every 3
months), were approved earlier.
Drugs for Irritable Bowel Syndrome
The Medical Letter on Drugs and Therapeutics • March 23, 2020; (Issue 1594)
Irritable bowel syndrome (IBS) is a common disorder
characterized by recurrent abdominal pain and altered
bowel habits, often accompanied by bloating.IBS
is classified according to the predominant...
Irritable bowel syndrome (IBS) is a common disorder
characterized by recurrent abdominal pain and altered
bowel habits, often accompanied by bloating.IBS
is classified according to the predominant bowel
symptom as IBS with constipation (IBS-C), IBS with
diarrhea (IBS-D), mixed type (IBS-M), or unclassified
(IBS-U). Alterations in the microbiome, stress
responses, sensory and motor function of the gut,
and host genetic factors may be contributing factors.
Since the exact cause of IBS is unknown, the goal of
treatment is symptom control.
Table: Safety of Drugs for IBS in Pregnancy and Lactation (online only)
The Medical Letter on Drugs and Therapeutics • March 23, 2020; (Issue 1594)
...
View the Table: Safety of Drugs for IBS in Pregnancy and Lactation
Drugs for Depression
The Medical Letter on Drugs and Therapeutics • February 24, 2020; (Issue 1592)
Complete remission of symptoms is the goal of
treatment for major depressive disorder; a partial
response is associated with an increased risk of
relapse. Improvement in symptoms can occur within
the first...
Complete remission of symptoms is the goal of
treatment for major depressive disorder; a partial
response is associated with an increased risk of
relapse. Improvement in symptoms can occur within
the first two weeks of treatment with an antidepressant,
but it may take 4-8 weeks to achieve a substantial
benefit. Following successful treatment of a first major
depressive episode, antidepressant treatment should
be continued at the same dose for at least 4-9 months
to consolidate recovery. In patients with recurrent
depressive episodes, long-term maintenance treatment
can reduce the risk of relapse.
Drugs for Anxiety Disorders
The Medical Letter on Drugs and Therapeutics • August 12, 2019; (Issue 1578)
Anxiety disorders (generalized anxiety disorder, panic
disorder, social anxiety disorder, and various phobias)
are the most common form of psychiatric illness. They
can be treated effectively with cognitive...
Anxiety disorders (generalized anxiety disorder, panic
disorder, social anxiety disorder, and various phobias)
are the most common form of psychiatric illness. They
can be treated effectively with cognitive behavioral
therapy (CBT) and/or pharmacotherapy. Obsessive-compulsive
disorder and posttraumatic stress
disorder are now considered separate entities in the
Diagnostic and Statistical Manual of Mental Disorders
(DSM-5); they can also be treated with CBT and many
of the same drugs.
Drugs for Chronic Insomnia
The Medical Letter on Drugs and Therapeutics • December 17, 2018; (Issue 1562)
Cognitive behavioral therapy for insomnia (CBT-I)
is recommended for initial treatment of chronic
insomnia. Pharmacologic treatment should be used in
addition to CBT-I when CBT-I alone is not...
Cognitive behavioral therapy for insomnia (CBT-I)
is recommended for initial treatment of chronic
insomnia. Pharmacologic treatment should be used in
addition to CBT-I when CBT-I alone is not effective.
Fremanezumab (Ajovy) and Galcanezumab (Emgality) for Migraine Prevention
The Medical Letter on Drugs and Therapeutics • November 5, 2018; (Issue 1559)
The FDA has approved two subcutaneously
injected calcitonin gene-related peptide (CGRP)
antagonists, fremanezumab-vfrm (Ajovy – Teva) and
galcanezumab-gnlm (Emgality – Lilly), for migraine
prevention in...
The FDA has approved two subcutaneously
injected calcitonin gene-related peptide (CGRP)
antagonists, fremanezumab-vfrm (Ajovy – Teva) and
galcanezumab-gnlm (Emgality – Lilly), for migraine
prevention in adults. Fremanezumab and galcanezumab
are the second and third subcutaneously
injected monoclonal antibodies that target the CGRP
pathway to be approved by the FDA for this indication;
erenumab-aooe (Aimovig), which targets the CGRP
receptor, was the first.
Erenumab (Aimovig) for Migraine Prevention
The Medical Letter on Drugs and Therapeutics • June 18, 2018; (Issue 1549)
The FDA has approved erenumab-aooe (Aimovig –
Amgen/Novartis), a once-monthly, subcutaneously-injected,
monoclonal antibody against the calcitonin
gene-related peptide receptor, for preventive...
The FDA has approved erenumab-aooe (Aimovig –
Amgen/Novartis), a once-monthly, subcutaneously-injected,
monoclonal antibody against the calcitonin
gene-related peptide receptor, for preventive treatment
of migraine in adults. It is the first drug in its class to
be approved by the FDA.
Nonopioid Drugs for Pain
The Medical Letter on Drugs and Therapeutics • February 12, 2018; (Issue 1540)
Nonopioid drugs can be used in the treatment of many
nociceptive and neuropathic pain conditions. Use of
opioids for pain will be reviewed in a future...
Nonopioid drugs can be used in the treatment of many
nociceptive and neuropathic pain conditions. Use of
opioids for pain will be reviewed in a future issue.
Drugs for Migraine
The Medical Letter on Drugs and Therapeutics • February 13, 2017; (Issue 1514)
An oral nonopioid analgesic may be sufficient for
treatment of mild to moderate migraine without severe
nausea or vomiting. A triptan is the drug of choice for
treatment of moderate to severe migraine. Use...
An oral nonopioid analgesic may be sufficient for
treatment of mild to moderate migraine without severe
nausea or vomiting. A triptan is the drug of choice for
treatment of moderate to severe migraine. Use of
a triptan early in an attack when pain is still mild to
moderate in intensity improves headache response
and reduces recurrence rates.
Comparison Table: Some Drugs for Migraine Prevention in Adults (online only)
The Medical Letter on Drugs and Therapeutics • February 13, 2017; (Issue 1514)
...
View the Comparison Table: Some Drugs for Migraine Prevention in Adults
Drugs for Irritable Bowel Syndrome
The Medical Letter on Drugs and Therapeutics • September 26, 2016; (Issue 1504)
Irritable bowel syndrome (IBS) is a common disorder
characterized by chronic, intermittent abdominal pain
or discomfort and altered bowel habits. It is subtyped
according to the predominant bowel symptom as...
Irritable bowel syndrome (IBS) is a common disorder
characterized by chronic, intermittent abdominal pain
or discomfort and altered bowel habits. It is subtyped
according to the predominant bowel symptom as IBS
with constipation (IBS-C), IBS with diarrhea (IBS-D),
mixed type (IBS-M), or unclassified (IBS-U). Since the
exact cause of IBS is unknown, the goal of treatment
is symptom control.
Drugs for Depression
The Medical Letter on Drugs and Therapeutics • July 4, 2016; (Issue 1498)
Complete remission of symptoms is the goal of
antidepressant therapy; partial response is associated
with an increased risk of relapse. Improvement can
occur within the first two weeks of drug therapy,
but...
Complete remission of symptoms is the goal of
antidepressant therapy; partial response is associated
with an increased risk of relapse. Improvement can
occur within the first two weeks of drug therapy,
but it may take 4-8 weeks to achieve a substantial
benefit. Fewer than 50% of patients with depression
respond to first-line pharmacotherapy, and the rate of
response decreases with each subsequent drug trial.
Following remission after a first episode of depression,
many experts recommend continuing antidepressant
treatment at the same dose for at least 6-12 months
to consolidate recovery. For patients with recurrent
depressive episodes, long-term maintenance therapy
can reduce the risk of recurrence.
Drugs for Insomnia
The Medical Letter on Drugs and Therapeutics • July 6, 2015; (Issue 1472)
Pharmacological treatment of insomnia includes
prescription drugs, non-prescription medications, and
"natural" remedies. Behavioral approaches such as
cognitive behavioral therapy, which are not...
Pharmacological treatment of insomnia includes
prescription drugs, non-prescription medications, and
"natural" remedies. Behavioral approaches such as
cognitive behavioral therapy, which are not discussed
here, are also used. Pharmacologic treatment and
behavioral therapy are often combined.
Drugs for Migraine
The Medical Letter on Drugs and Therapeutics • December 1, 2013; (Issue 136)
Treatment of migraine in the emergency department,
which may involve use of intravenous drugs, is not
discussed...
Treatment of migraine in the emergency department,
which may involve use of intravenous drugs, is not
discussed here.
Drugs for Psychiatric Disorders
The Medical Letter on Drugs and Therapeutics • June 1, 2013; (Issue 130)
Drugs are not the only treatment for psychiatric illness.
Psychotherapy remains an important component
in the management of these disorders, and cognitive
behavioral therapy (CBT) can be used for many...
Drugs are not the only treatment for psychiatric illness.
Psychotherapy remains an important component
in the management of these disorders, and cognitive
behavioral therapy (CBT) can be used for many of
them as well. Electroconvulsive therapy (ECT) has a
long history of efficacy and safety when drugs are
ineffective or cannot be used.
Drugs for Pain
The Medical Letter on Drugs and Therapeutics • April 1, 2013; (Issue 128)
Pain can be acute or chronic. The two major types of
chronic pain are nociceptive pain and neuropathic
pain. Nociceptive pain can be treated with nonopioid
analgesics or opioids. Neuropathic pain is less...
Pain can be acute or chronic. The two major types of
chronic pain are nociceptive pain and neuropathic
pain. Nociceptive pain can be treated with nonopioid
analgesics or opioids. Neuropathic pain is less responsive
to opioids and is often treated with adjuvant drugs
such as antidepressants and antiepileptics. Combining
different types of analgesics may provide an additive
analgesic effect without increasing adverse effects.
Drugs for Insomnia
The Medical Letter on Drugs and Therapeutics • July 1, 2012; (Issue 119)
Pharmacological treatment of insomnia includes prescription
drugs, non-prescription medications and
"natural" remedies. Behavioral changes are often
needed as...
Pharmacological treatment of insomnia includes prescription
drugs, non-prescription medications and
"natural" remedies. Behavioral changes are often
needed as well.
Drugs for Depression and Bipolar Disorder
The Medical Letter on Drugs and Therapeutics • May 1, 2010; (Issue 93)
Drugs are not the only treatment for mood disorders. Psychotherapy remains an important component in the management of these disorders, and electroconvulsive therapy (ECT) has a long history of efficacy and...
Drugs are not the only treatment for mood disorders. Psychotherapy remains an important component in the management of these disorders, and electroconvulsive therapy (ECT) has a long history of efficacy and safety
when drugs are ineffective, poorly tolerated or cannot be used. Some drugs are recommended here for indications that have not been approved by the FDA.
Drugs for Pain
The Medical Letter on Drugs and Therapeutics • April 1, 2010; (Issue 92)
Pain can be acute or chronic. Chronic pain has been broadly classified into two types: nociceptive and neuropathic. Nociceptive pain can be treated with nonopioid analgesics or opioids. Neuropathic pain is less...
Pain can be acute or chronic. Chronic pain has been broadly classified into two types: nociceptive and neuropathic. Nociceptive pain can be treated with nonopioid analgesics or opioids. Neuropathic pain is less responsive to opioids; adjuvant medicines such as antidepressants and anticonvulsants are often used to treat neuropathic pain. Combining different types of analgesics may provide an additive analgesic effect without increasing adverse effects.
Milnacipran (Savella) for Fibromyalgia
The Medical Letter on Drugs and Therapeutics • June 15, 2009; (Issue 1314)
Milnacipran (Savella - Forest), an oral selective serotonin and norepinephrine reuptake inhibitor (SNRI), is the third drug approved by the FDA for management of fibromyalgia. The 2 others are pregabalin, a...
Milnacipran (Savella - Forest), an oral selective serotonin and norepinephrine reuptake inhibitor (SNRI), is the third drug approved by the FDA for management of fibromyalgia. The 2 others are pregabalin, a gammaaminobutyric acid (GABA) analog also approved for treatment of diabetic neuropathy, post-herpetic neuralgia and epilepsy, and duloxetine, an SNRI also approved for treatment of depression, diabetic neuropathy and generalized anxiety disorder.
Drugs for Insomnia
The Medical Letter on Drugs and Therapeutics • March 1, 2009; (Issue 79)
The majority of patients with insomnia do not have a predisposing psychiatric disease. Rather, untreated insomnia may be a risk factor for development of psychiatric problems such as depression or...
The majority of patients with insomnia do not have a predisposing psychiatric disease. Rather, untreated insomnia may be a risk factor for development of psychiatric problems such as depression or anxiety.
Duloxetine (Cymbalta) for Fibromyalgia
The Medical Letter on Drugs and Therapeutics • July 28, 2008; (Issue 1291)
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...
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.
Drugs for Migraine
The Medical Letter on Drugs and Therapeutics • March 1, 2008; (Issue 67)
Some drugs for treatment of migraine attacks are listed in table 2 on page 18. Drugs for prevention of migraine are listed in table 3 on page 20. Treatment of migraine in the emergency room, which may involve...
Some drugs for treatment of migraine attacks are listed in table 2 on page 18. Drugs for prevention of migraine are listed in table 3 on page 20. Treatment of migraine in the emergency room, which may involve use of intravenous drugs, is not included here.
Extended-Release Cyclobenzaprine (Amrix)
The Medical Letter on Drugs and Therapeutics • December 17, 2007; (Issue 1276)
An extended-release formulation of the centrally-acting muscle relaxant cyclobenzaprine (Amrix - Cephalon) has been approved by the FDA for treatment of muscle spasms. Immediate-release (IR) cyclobenzaprine...
An extended-release formulation of the centrally-acting muscle relaxant cyclobenzaprine (Amrix - Cephalon) has been approved by the FDA for treatment of muscle spasms. Immediate-release (IR) cyclobenzaprine (Flexeril, and others) has been available since 1977.
Pregabalin (Lyrica) for Fibromyalgia
The Medical Letter on Drugs and Therapeutics • September 24, 2007; (Issue 1270)
Pregabalin (Lyrica - Pfizer) is the first drug approved by the FDA for management of fibromyalgia. When it was first marketed, pregabalin, which is structurally similar to gabapentin (Neurontin, and others),...
Pregabalin (Lyrica - Pfizer) is the first drug approved by the FDA for management of fibromyalgia. When it was first marketed, pregabalin, which is structurally similar to gabapentin (Neurontin, and others), was approved for treatment of neuropathic pain associated with postherpetic neuralgia and diabetic peripheral neuropathy and for adjunctive treatment of partial onset seizures in adults with epilepsy. It has also been prescribed off-label for other types of neuropathic pain such as sciatica.
Drugs for Psychiatric Disorders
The Medical Letter on Drugs and Therapeutics • June 1, 2006; (Issue 46)
Drugs are not the only treatment for psychiatric illness. Psychotherapy remains an important component in the management of these disorders, and cognitive behavioral therapy (CBT) is used for many of them as...
Drugs are not the only treatment for psychiatric illness. Psychotherapy remains an important component in the management of these disorders, and cognitive behavioral therapy (CBT) is used for many of them as well. Electroconvulsive therapy (ECT) has a long history of efficacy and safety when drugs are ineffective or cannot be used.
Drugs in the Elderly
The Medical Letter on Drugs and Therapeutics • January 16, 2006; (Issue 1226)
The physiologic changes that occur with aging can affect the pharmacokinetics and pharmacodynamics of many prescription and over-the-counter drugs, increasing the likelihood of adverse...
The physiologic changes that occur with aging can affect the pharmacokinetics and pharmacodynamics of many prescription and over-the-counter drugs, increasing the likelihood of adverse effects.
AmpliChip CYP450 Test
The Medical Letter on Drugs and Therapeutics • August 15, 2005; (Issue 1215)
The FDA recently cleared the AmpliChip CYP450 Test (Roche), which analyzes blood-derived DNA to detect genetic variations in the activity of cytochrome P450 (CYP) enzymes CYP2D6 and CYP2C19 and determines the...
The FDA recently cleared the AmpliChip CYP450 Test (Roche), which analyzes blood-derived DNA to detect genetic variations in the activity of cytochrome P450 (CYP) enzymes CYP2D6 and CYP2C19 and determines the metabolizer status of the patient. The test is intended to help guide clinicians in prescribing individualized drug therapy. About 25% of all drugs, including many antidepressants and antipsychotics, are substrates of either CYP2D6 or CYP2C19. The test is being promoted initially to psychiatrists.
Topiramate (Topamax) for Prevention of Migraine
The Medical Letter on Drugs and Therapeutics • January 31, 2005; (Issue 1201)
Patients with frequent, severe or disabling migraine headaches may benefit from taking a drug to prevent the attacks. Beta-blockers traditionally have been the prophylactic treatment of choice, but in recent...
Patients with frequent, severe or disabling migraine headaches may benefit from taking a drug to prevent the attacks. Beta-blockers traditionally have been the prophylactic treatment of choice, but in recent years some antiepileptic drugs such as valproate (Depakote, and others) and topiramate (Topamax) have also been used for this indication. Valproate was approved by the FDA for such use in 1996. Now topiramate has also been approved.
Drugs for Migraine
The Medical Letter on Drugs and Therapeutics • September 1, 2004; (Issue 25)
Drugs for treatment of migraine attacks are listed in the table on page 64. All of the oral drugs are most effective if taken early in an attack when the pain is mild (H Christoph-Diener et al, Neurology 2004;...
Drugs for treatment of migraine attacks are listed in the table on page 64. All of the oral drugs are most effective if taken early in an attack when the pain is mild (H Christoph-Diener et al, Neurology 2004; 63:520). Drugs for prevention of migraine are listed in the table on page 65. Treatment of migraine in the emergency room, which may involve use of intravenous drugs, is not included here.
Drugs for Pain
The Medical Letter on Drugs and Therapeutics • July 1, 2004; (Issue 23)
Three types of analgesic drugs are available: non-opioids, including aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; opioids; and adjuvant drugs that are not usually thought of...
Three types of analgesic drugs are available: non-opioids, including aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; opioids; and adjuvant drugs that are not usually thought of as analgesics, such as antidepressants, which can act as adjuvants when given with NSAIDs or opioids, or have analgesic activity of their own in some types of pain. Combining two different types of analgesics may provide an additive analgesic effect without necessarily increasing adverse effects.
Gabapentin (Neurontin) for Chronic Pain
The Medical Letter on Drugs and Therapeutics • April 12, 2004; (Issue 1180)
Gabapentin (Neurontin - Pfizer), which has been available in the US since 1994, is approved by the FDA only for treatment of partial epilepsy and postherpetic neuralgia, but is widely used off-label for a...
Gabapentin (Neurontin - Pfizer), which has been available in the US since 1994, is approved by the FDA only for treatment of partial epilepsy and postherpetic neuralgia, but is widely used off-label for a number of other indications, especially neuropathic pain syndromes. According to one report, among Medicaid recipients in Florida receiving gabapentin, 71% of prescriptions were for chronic pain and 8% for seizures and neuralgia ("The Pink Sheet" February 2, 2004; 66:30).
Drugs for Psychiatric Disorders
The Medical Letter on Drugs and Therapeutics • July 1, 2003; (Issue 11)
The number of drugs marketed for psychiatric indications has increased sharply in recent years. The recommendations in this article are based on the results of controlled trials and on the experience and...
The number of drugs marketed for psychiatric indications has increased sharply in recent years. The recommendations in this article are based on the results of controlled trials and on the experience and opinions of Medical Letter consultants. Interactions with other drugs can be found in The Medical Letter Handbook of Adverse Drug Interactions, 2003.
Drug Interactions
The Medical Letter on Drugs and Therapeutics • June 8, 2003; (Issue 1158)
Changes caused by one drug in the absorption, distribution, metabolism or excretion of another may lead to a pharmacokinetic adverse drug interaction (DN Juurlink et al, JAMA 2003; 289:1652). Additive drug...
Changes caused by one drug in the absorption, distribution, metabolism or excretion of another may lead to a pharmacokinetic adverse drug interaction (DN Juurlink et al, JAMA 2003; 289:1652). Additive drug interactions, such as vasodilation caused by both sildenafil (Viagra) and nitrates, can also have adverse effects.
Generic drugs
The Medical Letter on Drugs and Therapeutics • October 14, 2002; (Issue 1141)
When patents expire on brand-name drugs and generic formulations become available, patients and managed care organizations may express a preference for the lower-cost generics. Are they equivalent to the...
When patents expire on brand-name drugs and generic formulations become available, patients and managed care organizations may express a preference for the lower-cost generics. Are they equivalent to the brand-name product?
Drugs for Pain
The Medical Letter on Drugs and Therapeutics • August 21, 2000; (Issue 1085)
Three types of analgesic drugs are available: first, non-opioids, including aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; second, opioids; and third, drugs not usually thought...
Three types of analgesic drugs are available: first, non-opioids, including aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; second, opioids; and third, drugs not usually thought of as analgesics, which act as adjuvants when given with NSAIDs or opioids, or have analgesic activity of their own in some types of pain. Non-opioids can be given concurrently with opioids for an additive analgesic effect.
Drug Interactions with St. John's Wort
The Medical Letter on Drugs and Therapeutics • June 26, 2000; (Issue 1081)
Even though its effectiveness has not been established, many patients take St. John's Wort (Hypericum perforatum), an over-the-counter herbal extract, to treat symptoms of depression, often without the...
Even though its effectiveness has not been established, many patients take St. John's Wort (Hypericum perforatum), an over-the-counter herbal extract, to treat symptoms of depression, often without the knowledge of their physicians. Recent reports indicate that St. John's wort interacts adversely with a number of drugs.
SAMe For Depression
The Medical Letter on Drugs and Therapeutics • November 5, 1999; (Issue 1065)
S-adenosyl-methionine (SAM; SAMe; ademetionine; adomet), an endogenous compound synthesized from methionine and adenosine-triphosphate (ATP), has been marketed in stores and on the internet as a dietary...
S-adenosyl-methionine (SAM; SAMe; ademetionine; adomet), an endogenous compound synthesized from methionine and adenosine-triphosphate (ATP), has been marketed in stores and on the internet as a dietary supplement to promote "emotional well being."
Drug Interactions
The Medical Letter on Drugs and Therapeutics • July 2, 1999; (Issue 1056)
Reports of adverse interactions between drugs continue to accumulate. Recently, the FDA has expanded the recommendations on drug interactions found in the package inserts of new...
Reports of adverse interactions between drugs continue to accumulate. Recently, the FDA has expanded the recommendations on drug interactions found in the package inserts of new drugs.
Drugs for Depression and Anxiety
The Medical Letter on Drugs and Therapeutics • April 9, 1999; (Issue 1050)
The number of drugs marketed for treatment of depression has increased in recent years. Antidepressants are generally also effective for treatment of...
The number of drugs marketed for treatment of depression has increased in recent years. Antidepressants are generally also effective for treatment of anxiety.
New "Triptans" and Other Drugs for Migraine
The Medical Letter on Drugs and Therapeutics • October 9, 1998; (Issue 1037)
Three new 5-HT1 receptors agonissts ('triptans') have been marketed recently for treatment of migraine. Some drugs for prevention of migraine are listed in the table on page 99. Treatment of migraine in the...
Three new 5-HT1 receptors agonissts ('triptans') have been marketed recently for treatment of migraine. Some drugs for prevention of migraine are listed in the table on page 99. Treatment of migraine in the emergency room, which may involve use of intravenous drugs, is not included here.
Drugs for Pain
The Medical Letter on Drugs and Therapeutics • August 14, 1998; (Issue 1033)
Three types of analgesic drugs are available: first, non-opioids, including aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; second, opioids; and third, some drugs not usually...
Three types of analgesic drugs are available: first, non-opioids, including aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; second, opioids; and third, some drugs not usually thought of as analgesics, which act as adjuvants when given with NSAIDs or opioids, or have analgesic activity of their own in some types of pain.
Pentosan for Interstitial Cystitis
The Medical Letter on Drugs and Therapeutics • June 6, 1997; (Issue 1002)
Pentosan polysulfate sodium (Elmiron - Baker Norton), a semi-synthetic mucopolysaccharide structurally similar to heparin, has been approved by the US Food and Drug Administration for oral treatment of...
Pentosan polysulfate sodium (Elmiron - Baker Norton), a semi-synthetic mucopolysaccharide structurally similar to heparin, has been approved by the US Food and Drug Administration for oral treatment of interstitial cystitis.
Drugs for Psychiatric Disorders
The Medical Letter on Drugs and Therapeutics • April 11, 1997; (Issue 998)
The number of new drugs marketed for psychiatric indications has increased sharply in recent years. The recommendations in this article are based on the results of controlled trials and on the experience and...
The number of new drugs marketed for psychiatric indications has increased sharply in recent years. The recommendations in this article are based on the results of controlled trials and on the experience and opinions of Medical Letter consultants. Interactions with other drugs can be found in The Medical Letter Handbook of Adverse Drug Interactions, 1997.
Mirtazapine - A New Antidepressant
The Medical Letter on Drugs and Therapeutics • December 20, 1996; (Issue 990)
Mirtazapine (mir taz a peen; Remeron - Organon) has been approved by the US Food and Drug Administration for treatment of depression. A tetracyclic piperazinoazepine, it is an analog of mianserin, an...
Mirtazapine (mir taz a peen; Remeron - Organon) has been approved by the US Food and Drug Administration for treatment of depression. A tetracyclic piperazinoazepine, it is an analog of mianserin, an antidepressant available in Europe, but is structurally unrelated to antidepressants previously available in the USA.
Anastrozole for Metastatic Breast Cancer
The Medical Letter on Drugs and Therapeutics • July 5, 1996; (Issue 978)
Anastrozole (Arimidex - Zeneca), a selective nonsteroidal aromatase inhibitor, has been approved by the US Food and Drug Administration (FDA) for treatment of postmenopausal women with advanced breast cancer...
Anastrozole (Arimidex - Zeneca), a selective nonsteroidal aromatase inhibitor, has been approved by the US Food and Drug Administration (FDA) for treatment of postmenopausal women with advanced breast cancer that has progressed during treatment with tamoxifen (Nolvadex, and others).
Nefazodone for Depression
The Medical Letter on Drugs and Therapeutics • April 14, 1995; (Issue 946)
Nefazodone (Serzone - Bristol-Myers Squibb) was recently approved by the US Food and Drug Administration for treatment of depression. A phenylpiperazine, nefazodone is chemically related to trazodone...
Nefazodone (Serzone - Bristol-Myers Squibb) was recently approved by the US Food and Drug Administration for treatment of depression. A phenylpiperazine, nefazodone is chemically related to trazodone (Desyrel, and others).
Drugs for Migraine
The Medical Letter on Drugs and Therapeutics • March 3, 1995; (Issue 943)
Drugs are used both to prevent and treat migraine symptoms. The effectiveness of such use can be difficult to evaluate, even with double-blind controlled trials, because migraine is episodic, response to...
Drugs are used both to prevent and treat migraine symptoms. The effectiveness of such use can be difficult to evaluate, even with double-blind controlled trials, because migraine is episodic, response to placebo is frequent, and patients vary in response to a given agent (KMA Welch, N Engl J Med, 329:1476, 1993; SD Silberstein and RB Lipton, Neurology, 44 suppl 7:S6, Oct 1994).
Venlafaxine - A New Antidepressant
The Medical Letter on Drugs and Therapeutics • June 10, 1994; (Issue 924)
Venlafaxine hydrochloride (Effexor - Wyeth-Ayerst) was recently approved by the US Food and Drug Administration for treatment of depression. An aminomethyl-benzyl- cyclohexanol, it is chemically related to...
Venlafaxine hydrochloride (Effexor - Wyeth-Ayerst) was recently approved by the US Food and Drug Administration for treatment of depression. An aminomethyl-benzyl- cyclohexanol, it is chemically related to bupropion (Wellbutrin).
Choice of an Antidepressant
The Medical Letter on Drugs and Therapeutics • March 19, 1993; (Issue 892)
Since the introduction of fluoxetine (Prozac - Medical Letter, 30:45, 1988), bupropion (Wellbutrin - Medical Letter, 31:97, 1989), sertraline (Zoloft - Medical Letter, 34:47, 1992) and paroxetine (Paxil -...
Since the introduction of fluoxetine (Prozac - Medical Letter, 30:45, 1988), bupropion (Wellbutrin - Medical Letter, 31:97, 1989), sertraline (Zoloft - Medical Letter, 34:47, 1992) and paroxetine (Paxil - this issue), the choice of an antidepressant has become more difficult. Should these widely prescribed new drugs replace tricyclic antidepressants such as amitriptyline (Elavil, and others), imipramine (Tofranil, and others), or nortriptyline (Aventyl, and others) for treatment of most patients with depression?
Drugs for Pain
The Medical Letter on Drugs and Therapeutics • January 8, 1993; (Issue 887)
Three types of analgesic drugs are available in the USA: first, aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; second, opioids; and third, drugs not usually thought of as...
Three types of analgesic drugs are available in the USA: first, aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; second, opioids; and third, drugs not usually thought of as analgesics, which act as adjuvants when given with NSAIDs or opioids, or have analgesic activity of their own in some types of pain. (American Pain Society, Principles of analgesic Use, 3rd ed, Skokie, illinois: American pain society, 1992).
Sertraline For Treatment Of Depression
The Medical Letter on Drugs and Therapeutics • May 15, 1992; (Issue 870)
Sertraline (Zoloft - Roerig), a serotonin reuptake inhibitor, was recently approved for marketing by the US Food and Drug Administration for treatment of depression. Another serotonin reuptake inhibitor,...
Sertraline (Zoloft - Roerig), a serotonin reuptake inhibitor, was recently approved for marketing by the US Food and Drug Administration for treatment of depression. Another serotonin reuptake inhibitor, fluoxetine (Prozac), is prescribed more frequently in the USA than any other antidepressant (Medical Letter, 32:83, 1990).
Bupropion For Depression
The Medical Letter on Drugs and Therapeutics • November 3, 1989; (Issue 804)
Bupropion (Wellbutrin - Burroughs Wellcome) was recently marketed in the USA for treatment of depression. First approved by the Food and Drug Administration in late 1985, the drug was withdrawn from the...
Bupropion (Wellbutrin - Burroughs Wellcome) was recently marketed in the USA for treatment of depression. First approved by the Food and Drug Administration in late 1985, the drug was withdrawn from the market in early 1986 because of a high incidence of seizures in one study.
Oral Hypnotic Drugs
The Medical Letter on Drugs and Therapeutics • March 10, 1989; (Issue 787)
Three benzodiazepines and 16 other compounds are marketed in the USA for treatment of insomnia. Many authorities believe that insomnia is overdiagnosed and overtreated (MK Erman, ed, Sleep Disorders,...
Three benzodiazepines and 16 other compounds are marketed in the USA for treatment of insomnia. Many authorities believe that insomnia is overdiagnosed and overtreated (MK Erman, ed, Sleep Disorders, Psychiatr Clin North Am, Volume 10, Dec 1987).
Fluoxetine For Depression
The Medical Letter on Drugs and Therapeutics • April 22, 1988; (Issue 764)
Fluoxetine (Prozac - Dista), a phenylpropylamide, is the first serotonin-reuptake blocker introduced in the USA for treatment of . It is being promoted as causing fewer adverse effects than other...
Fluoxetine (Prozac - Dista), a phenylpropylamide, is the first serotonin-reuptake blocker introduced in the USA for treatment of . It is being promoted as causing fewer adverse effects than other antidepressants. Claims of greater safety and patient tolerability have often been made for new non-tricyclic antidepressants in recent years, but unpredicted adverse effects have emerged with widespread use, including priapism with trazodone (Desyrel - Medical Letter, 26:35, 1984) and fatal hemolytic anemia with nomifensine (Merital - Medical Letter, 27:73, 1985).