AFP DEPARTMENT COLLECTION

STEPS

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.

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.


Aug 15, 2015 Issue
Vorapaxar (Zontivity) for the Prevention of Thrombotic Cardiovascular Events
Vorapaxar should be limited to select patients with a history of MI or peripheral arterial disease who desire additional treatment for the prevention of MI.


Jun 15, 2015 Issue
Dapagliflozin (Farxiga) for Type 2 Diabetes Mellitus
Dapagliflozin will lower A1C levels by an average of 0.7 percentage points when used alone or by an average of 0.5 percentage points when added to metformin therapy. Its effect on diabetes-associated morbidity and mortality has not been studied, and although it is well tolerated, there is an association with bladder cancer and diabetic ketoacidosis.


Apr 15, 2015 Issue
Naltrexone/Bupropion (Contrave) for Weight Loss
Naltrexone/bupropion produces clinically significant weight loss when combined with a diet and exercise program. It decreases body weight in patients with diabetes, but its effect on diabetic outcomes is not known. A significant proportion of patients will experience adverse effects.


Mar 1, 2015 Issue
Vortioxetine (Brintellix) for the Treatment of Depression
Current evidence does not support the routine use of vortioxetine in the treatment of depression. Family physicians most often encounter patients with mild to moderate depression, and vortioxetine has not been studied in this population. There is no clear benefit of using vortioxetine over other more affordable options in its class.


Dec 15, 2014 Issue
Lorcaserin (Belviq) for Weight Loss
Lorcaserin, combined with diet and exercise, can be used to produce additional weight loss, although the effect on morbidity and mortality is not known. It should be discontinued in patients who do not lose at least 5% of their body weight in the first 12 weeks because they are unlikely to have any additional weight loss.


Oct 15, 2014 Issue
Phentermine/Topiramate (Qsymia) for Chronic Weight Management
Phentermine/topiramate has been shown to be a good option for sustained weight loss in patients who are unable to lose weight with diet and exercise alone. It should not be given to patients with a history of significant heart disease, and women of childbearing age should use contraception and have regular pregnancy tests when taking phentermine/topiramate.


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