This department includes information about new drugs from the perspective of the five attributes to be considered when weighing the advantages of one drug over another: Safety, Tolerability, Effectiveness, Price, and Simplicity.

Oct 15, 2016 Issue
Sacubitril/Valsartan (Entresto) for Heart Failure
Sacubitril/valsartan provides a small mortality benefit and decreases heart failure–related hospitalizations over and above an ACE inhibitor. It may be used in place of an ACE inhibitor in patients receiving optimal doses of guideline-directed medical therapy that includes ACE inhibitors, beta blockers, and aldosterone antagonists.

Sep 15, 2016 Issue
Ivermectin 1% Cream (Soolantra) for Inflammatory Lesions of Rosacea
Ivermectin cream is an effective treatment for moderate to severe pustular rosacea, but it is more expensive than some other available treatments and has not been studied in patients with milder forms of rosacea. Generic metronidazole cream is a less expensive alternative, and long-term oral doxycycline may be suitable for patients who want a more affordable alternative to a topical agent.

Aug 15, 2016 Issue
Alirocumab (Praluent) for Treatment of Hyperlipidemia
Alirocumab is a novel lipid-lowering therapy that is highly effective at lowering LDL cholesterol when used in addition to statin therapy and diet. Its use should be limited to patients with either heterozygous familial hypercholesterolemia or clinical atherosclerotic cardiovascular disease who do not tolerate an adequate dose of a statin.

Jul 15, 2016 Issue
Liraglutide (Saxenda) for Weight Loss
Liraglutide, combined with lifestyle counseling, produces a clinically significant and sustained weight loss that continues as long as it is used. Nausea and vomiting, however, are common adverse effects, and about one in 10 patients will discontinue treatment.

Jun 15, 2016 Issue
Suvorexant (Belsomra) for Insomnia
Suvorexant effectively increases total sleep time and decreases time to sleep onset. Because of its risk of abuse, significant incidence of next-day impairment, and high cost, it should be reserved for use in patients for whom other insomnia therapies, such as cognitive behavior therapy and lifestyle changes, have failed.

May 15, 2016 Issue
Flibanserin (Addyi) for Hypoactive Sexual Desire Disorder in Premenopausal Women
Although flibanserin results in a modest improvement in the number of satisfying sexual events (approximately one more per month vs. placebo), it does not improve other measures, is considerably expensive, and has significant adverse effects.

Apr 15, 2016 Issue
Ivabradine (Corlanor) for Heart Failure
In patients with stable systolic heart failure already on maximal medication therapy, adding ivabradine may reduce the number of hospitalizations related to heart failure (NNT for two years = 20), but it does not reduce cardiovascular mortality. In addition, many patients will not tolerate the drug and will stop taking it. Patients should be monitored for the development of atrial fibrillation and bradycardia.

Feb 15, 2016 Issue
Conjugated Estrogens/Bazedoxifene (Duavee) for Menopausal Symptoms
Conjugated estrogens/bazedoxifene is effective for the treatment of menopausal symptoms and may be better tolerated than conjugated estrogens/medroxyprogesterone. It will maintain bone mineral density in the lumbar spine and hip, but its effect on fractures is not known. Cardiovascular safety beyond two years is not known.

Dec 15, 2015 Issue
Timothy Grass Pollen Allergen Extract (Grastek) for Allergic Rhinitis
Timothy grass pollen allergen extract produces small improvements in allergic rhinitis symptoms and the use of allergy relief medications, with a high rate of adverse effects. It may, however, be an option for patients who desire an alternative to standard allergy symptom relief but who do not want to begin injectable desensitization treatment.

Oct 15, 2015 Issue
Levomilnacipran (Fetzima) for Major Depressive Disorder
Levomilnacipran should not be used in patients with mild to moderate depression until studies have proven its effectiveness. It is somewhat effective in patients with moderate to severe depression. The short-term adverse effect profile of levomilnacipran is similar to that of other SNRIs.

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