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)

[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...]

[101] Study 329: Why is it so important?

November 22, 2016 Therapeutics Letter 2 Comments

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Study 329 is a GlaxoSmithKline (GSK) sponsored trial with 22 academic authors that compared paroxetine, imipramine, and placebo for adolescent depression. In this trial 275 adolescents with major depression were randomized in a double-blind fashion to paroxetine (93), imipramine (95) or placebo (87) for 8 weeks. Those who completed 8 weeks were studied in a 6-month continuation phase. Published … [Read more...]

[100] Questioning the basis of approval for non-insulin glucose lowering drugs

September 16, 2016 Therapeutics Letter 10 Comments

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Glucose lowering drugs are commonly prescribed in British Columbia, and 44% of adults with type 2 diabetes are receiving more than one drug (see Table). Annual spending on non-insulin glucose lowering drugs in Canada was $748 million in 2013.1 When these drugs are taken, the underlying unproven assumption is that by lowering glucose they will prevent the complications of diabetes: premature … [Read more...]

[99] Comparative effectiveness of proton pump inhibitors

June 28, 2016 Therapeutics Letter 9 Comments

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Six previous Therapeutics Letters reported information about the benefits and harms of different proton pump inhibitors (PPIs).1-6 These drugs work by irreversibly inhibiting gastric H+K+ ATPase (the proton pump) in the stomach. They inhibit both basal and stimulated acid secretion and are used in a number of clinical settings: gastroesophageal reflux disease (GERD), reflux esophagitis, peptic … [Read more...]

[98] Does SPRINT change our approach to blood pressure targets?

April 7, 2016 Therapeutics Letter 3 Comments

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Therapeutics Letter #821 summarized evidence from the Cochrane systematic review, Treatment blood pressure targets for hypertension.2 The Cochrane review was based on the 7 randomized controlled trials (RCTs) designed to test treatment targets that were available as of October 2008. The conclusion was that “Treating patients to lower than standard blood pressure (BP) targets (≤ 140-160/90-100 … [Read more...]

[97] Intravenous (IV) iron for severe iron deficiency

February 24, 2016 Therapeutics Letter 4 Comments

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Anemia affects about one-third of humans; iron (Fe) deficiency is the most common cause.1 In Canada (2009-11), deficiency defined as serum ferritin < 15 mcg/L was estimated to affect 13% of females aged 12-19, and 9% of females aged 20-49.2 This estimate is probably low, as the ferritin cutoff is arbitrary and it excludes residents of First Nation reserves, where nutrition is often inferior to … [Read more...]

Therapeutics Letter

[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

[101] Study 329: Why is it so important?

[100] Questioning the basis of approval for non-insulin glucose lowering drugs

[99] Comparative effectiveness of proton pump inhibitors

[98] Does SPRINT change our approach to blood pressure targets?

[97] Intravenous (IV) iron for severe iron deficiency

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