Therapeutics Letter

This is a bi-monthly publication targeting identified problematic therapeutic issues (brief, simple, practical messages). The process involves a literature review and development of the message by different working groups of the Therapeutics Initiative. A draft of the Letter is reviewed by specialists who are expert in the particular therapeutic area and all members and associates of the Therapeutics Initiative before the Letter is disseminated. The Therapeutics Initiative is a full member of the International Society of Drug Bulletins.

ISSN: 2369-8691 (Online)
ISSN: 2369-8683 (Print)

[111] Deprescribing Proton Pump Inhibitors

June 26, 2018 Therapeutics Letter 3 Comments

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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...]

[110] Stimulants for ADHD in children: Revisited

May 28, 2018 Therapeutics Letter 4 Comments

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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

February 6, 2018 Therapeutics Letter Leave a Comment

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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...]

[108] Drugs to avoid

January 4, 2018 Therapeutics Letter 7 Comments

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In two previous Therapeutics Letters we presented Clinical Pearls from Prescrire International.1,2 Prescrire is one of a small number of drug bulletins in the world, which reports on prescription drugs and is completely independent of industry influence. The front page of Prescrire International states, “Funded by subscribers. No advertising, no grants, no shareholders.” The inside jacket … [Read more...]

[107] EMPA-REG OUTCOME Trial: What does it mean?

November 20, 2017 Therapeutics Letter 7 Comments

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Empagliflozin (Jardiance) inhibits the sodium-glucose co-transporter 2 (SGLT2), which is the predominant mechanism responsible for reabsorption of glucose from the glomerular filtrate back into the circulation. By inhibiting SGLT2, empagliflozin increases urinary glucose excretion.1 Empagliflozin was approved by Health Canada in 2015 to improve glycemic control in adult patients with type 2 … [Read more...]

[106] Using Best Evidence for the Management of Hypertension

September 15, 2017 Therapeutics Letter 3 Comments

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Elevated blood pressure, commonly referred to as hypertension, is prevalent and has become “big business”. As a result much that is written about hypertension is conflicted and influenced by vested interests. It is thus important to know how to find the least biased evidence. Adding to the complexity, the term “evidence” is used in many different ways with many meanings. This Letter uses the term … [Read more...]

[105] Is cyclobenzaprine useful for pain?

July 24, 2017 Therapeutics Letter Leave a Comment

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Cyclobenzaprine is a tricyclic molecule discovered in 1956 that is structurally related to amitriptyline and imipramine. Evaluated first as a possible tranquilizer, it was noted to have atropine-like properties in animals.1 In Canada, Merck Frosst Research Laboratories envisaged cyclobenzaprine as a centrally active skeletal muscle relaxant.2 However, it was soon apparent that despite being … [Read more...]

[104] Does Medication Review improve health?

May 10, 2017 Therapeutics Letter Leave a Comment

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Medication Review (MR) involves a structured and comprehensive assessment of a patient’s medications with the aim of identifying and resolving problems in order to improve health.1 It is different from Best Possible Medication History (BPMH), which is limited to documenting a list of a patient’s prescribed and non-prescription medicines using multiple reliable sources of information.2 What is the … [Read more...]

[103] Is the current ‘glucocentric’ approach to management of type 2 diabetes misguided?

March 15, 2017 Therapeutics Letter 8 Comments

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A recent Alberta modeling study suggests that lifetime risk of diabetes is now 50% for non-indigenous Canadians and 80% for First Nations Canadians.1 If true, type 2 diabetes (DM2) will become the most common primary care diagnosis. Costs including medical visits, capillary blood glucose (CBG) testing, laboratory tests, and drug therapies will threaten other social priorities. In 2013, British … [Read more...]

[102] Indacaterol for chronic obstructive pulmonary disease

January 26, 2017 Therapeutics Letter Leave a Comment

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Chronic obstructive pulmonary disease (COPD) is an inflammatory condition characterized by irreversible airflow obstruction. It is caused by exposure to noxious particles or gases, with exposure to cigarette smoke the most common cause. Several classes of drugs can be prescribed: short and long-acting beta2 (β2) agonist, short and long-acting antimuscarinic, inhaled corticosteroids and … [Read more...]

Therapeutics Letter

[111] Deprescribing Proton Pump Inhibitors

[110] Stimulants for ADHD in children: Revisited

[109] Inhaled long acting β2 agonists for COPD

[108] Drugs to avoid

[107] EMPA-REG OUTCOME Trial: What does it mean?

[106] Using Best Evidence for the Management of Hypertension

[105] Is cyclobenzaprine useful for pain?

[104] Does Medication Review improve health?

[103] Is the current ‘glucocentric’ approach to management of type 2 diabetes misguided?

[102] Indacaterol for chronic obstructive pulmonary disease

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