[117] Gabapentin and pregabalin: Are high doses justified?
Analgesia once seemed a relatively straightforward aspect of medicine. Recommendations in textbooks and guidelines were definitive, albeit heavily conflicted. Even recent guidelines encourage dose titration, based on an implicit, if unsupported, notion that more is likely to be better.1 Recent experiments and systematic reviews show that drugs seldom outperform placebo significantly in chronic … [Read more...]
[116] New drug for cystic fibrosis: Regulatory approval, clinical uncertainty?
A new drug for cystic fibrosis (CF) that combines lumacaftor and ivacaftor (Orkambi), was approved by Health Canada (HC) in 2016 to treat people age 12 and older with the most frequent CF genetic mutation: homozygous F508 deletion of the cystic fibrosis transmembrane regulator (CFTR) gene. This affects 50% of the Canadian CF population. In CF, mucus membranes do not release an adequate amount … [Read more...]
[115] Cannabinoids for Chronic Pain
Canada's parliament legalized the recreational use of herbal cannabis (marijuana) in October 2018. The well-publicized limitations of clinical research and well-recognized side effects such as cannabis intoxication have not deterred people from seeking out and using herbal cannabis for chronic pain in increasing numbers. This is occurring with or without a physician’s authorization.1 In fact, half … [Read more...]
[114] Shingrix: A New Vaccine for Shingles
Herpes zoster (HZ) or “shingles” occurs when the varicella zoster virus (VZV), lying latent in the sensory ganglia, becomes reactivated. An HZ outbreak typically presents as a vesicular skin eruption most characteristically forming a painful girdle around one side of the thorax. The rash and pain usually resolve over a few weeks. However, about 10% of patients with shingles develop some degree of … [Read more...]
[113] How well do you know your anticholinergic (antimuscarinic) drugs?
Anticholinergic drugs, prescribed for a variety of clinical conditions, are amongst the most frequently used prescription drugs in BC (Table 1). Also referred to as “antimuscarinics,” such drugs specifically block muscarinic receptors for acetylcholine (ACh).1 Muscarinic ACh receptors are important in the parasympathetic nervous system that governs heart rate, exocrine glands, smooth muscles, as … [Read more...]
[112] Antidepressant Withdrawal Syndrome
Antidepressant drugs are associated with drug tolerance, dependence and a discontinuation syndrome similar to other drug classes such as the opiates and benzodiazepines. The effects of stopping any antidepressant should be more precisely termed “withdrawal syndrome” instead of “antidepressant discontinuation syndrome.” What is it? Antidepressant withdrawal syndrome refers to physical and … [Read more...]
[111] Deprescribing Proton Pump Inhibitors
The first PPI was approved in Canada in 1988. Pronounced and durable reduction of stomach acid production made omeprazole a “blockbuster drug”, spawning multiple imitators. Eventually this included (as patent extensions) the single enantiomers esomeprazole and dexlansoprazole. Prescription PPIs are approved for peptic ulcer disease (PUD), gastroesophageal reflux (GERD), and non-ulcer dyspepsia. … [Read more...]
Shingrix vaccine for herpes zoster
Drug Assessment Working Group Systematic Review Report Efficacy and safety of adjuvanted herpes zoster subunit vaccine October 2018 Background Herpes zoster (HZ) or “shingles” infection occurs through the reactivation of latent varicella zoster virus (VZV) in the sensory ganglia. The outbreak typically presents as a unilateral vesiculopustular rash along a dermatome, with accompanying … [Read more...]
[110] Stimulants for ADHD in children: Revisited
This Letter reviews our previous publications and research on this topic and explores whether our publications have led to a change in prescribing of stimulants to children in BC. Despite concerns, stimulant drug treatment of childhood attention-deficit/hyperactivity disorder (ADHD) has increased worldwide over the last two decades.1 The optimal management of this behavioral condition remains … [Read more...]
[109] Inhaled long acting β2 agonists for COPD
In Therapeutics Letter #1021 we reviewed the inhaled long acting β2 agonist (LABA) indacaterol for chronic obstructive pulmonary disease (COPD). We concluded “There are no proven clinically meaningful benefits in terms of reduction in mortality or total serious adverse events…” for this indication based on 12 trials in 6,947 patients. In this Letter we report systematic reviews of 3 other inhaled … [Read more...]
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