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Therapeutics Letter

This is a 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 circulated for comment among specialists who are expert in the particular therapeutic area and all members and associates of the Therapeutics Initiative before the Letter is finalized and disseminated.

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)

[113] How well do you know your anticholinergic (antimuscarinic) drugs?

Therapeutics Letter 10 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 6 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...]

[111] Deprescribing Proton Pump Inhibitors

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

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

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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

Therapeutics Letter 9 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?

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

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?

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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?

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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...]

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