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Therapeutics Letter

This is a bimonthly publication targeting identified problematic therapeutic issues in a brief, simple and practical manner. The process leading up to publication involves a rigorous, systematic literature review by different working groups of the Therapeutics Initiative, the creation of a draft which is circulated for comment among a sizeable group of over 100 local, national and international specialists with expertise in the particular therapeutic area and the commission of original artwork/illustration. The message is developed collaboratively by different working groups of the Therapeutics Initiative. The current Editor in Chief is Dr. Tom Perry, Chair of the Education Working Group of the Therapeutics Initiative.

Therapeutics Letters on common therapies have been regularly published since 1994 and distributed free of charge to physicians and pharmacists in British Columbia to increase awareness and improve prescription habits.

The Therapeutics Letter is a member of the International Society of Drug Bulletins (ISDB), a world-wide network of independent drug bulletins that aims to promote international exchange of quality information on drugs and therapeutics.

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

[121] Twenty-Five Pearls from 25 years (part 1)

Therapeutics Letter 9 Comments

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The Therapeutics Initiative is celebrating its 25th anniversary this year, in part by highlighting key conclusions from the 120 issues of the Therapeutics Letter published so far. In this first of a 2-part series we present 13 “clinical pearls” found in Letters published between 1994 and 2005. 1: Thiazides are clearly the drug of first choice for the treatment of uncomplicated hypertension Drugs … [Read more...]

[120] Routine VTE prophylaxis: Is there a net health benefit?

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Prophylaxis of venous thromboembolism (VTE) with low molecular weight heparin (LMWH) is now common for hospitalized non-surgical patients in British Columbia and much of North America. This includes patients who are at very low risk for a VTE. VTE events include deep vein thrombosis (DVT), usually in the legs, which can be either symptomatic or asymptomatic, as well as pulmonary embolism … [Read more...]

[119] Epinephrine autoinjectors available in Canada

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Anaphylaxis is one of the most dramatic health crises. Experiencing or witnessing this acute and serious allergy event is a powerful incentive to learn more, yet many health care professionals must act without the benefit of personal experience. The Canadian Institute for Health Information estimates that anaphylaxis makes up 8% of the approximately 171,000 annual emergency department visits for … [Read more...]

[118] Trends in utilization of proton pump inhibitors in British Columbia

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The first three Therapeutics Letters focused on complaints related to the upper gastrointestinal tract, a common presentation to the primary care physician.1-3 These Letters reviewed evidence about H2-blockers, eradication of Helicobacter pylori, and drugs used for gastroesophageal reflux. However, they also raised concerns about chronic acid suppression by daily dosing of omeprazole, the first … [Read more...]

[117] Gabapentin and pregabalin: Are high doses justified?

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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?

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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

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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

Therapeutics Letter 15 Comments

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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?

Therapeutics Letter 12 Comments

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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

Therapeutics Letter 7 Comments

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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...]

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