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.

May 1, 2012 Issue
Tapentadol (Nucynta) for Treatment of Pain
Tapentadol is a DEA schedule II opioid medication with a safety profile, duration of action, frequency of dosing, and analgesic effect similar to those of other oral narcotics, although it is more expensive. At low doses, immediate-release tapentadol is better tolerated than oxycodone in terms of gastrointestinal adverse effects, and in the long term, extended-release tapentadol is better tolerated than controlled-release oxycodone.

Feb 15, 2012 Issue
Denosumab (Prolia) for Treatment of Postmenopausal Osteoporosis
Prolia is an expensive method of preventing osteoporotic hip fractures, and is associated with significant adverse effects. Safer, less expensive options exist for preventing fracture in high-risk women.

Dec 15, 2011 Issue
Dabigatran (Pradaxa) for Prevention of Stroke in Atrial Fibrillation
Dabigatran is superior to warfarin for stroke prevention in patients with atrial fibrillation, with similar rates of major bleeding. Because it does not require laboratory monitoring, dabigatran therapy is less complicated than warfarin therapy, but it costs significantly more.

Oct 15, 2011 Issue
Tranexemic Acid (Lysteda) for Cyclic Heavy Menstrual Bleeding
Tranexamic acid is a nonhormonal option that reduces menstrual blood loss and improves quality of life in patients with heavy menstrual bleeding. It is more expensive than nonsteroidal anti-inflammatory drugs and hormonal therapies, but is an option when these treatments are not desired or recommended.

Aug 15, 2011 Issue
Doxepin (Silenor) for Insomnia
In older patients with primary insomnia, Silenor can increase duration of sleep without next-day effects. However, it does not significantly decrease the time to sleep onset, and it is less effective in younger adults.

Jun 15, 2011 Issue
Adapelene/Benzoyl Peroxide (Epiduo) for Acne Vulgaris
Adapalene/benzoyl peroxide is as effective as other combination products for the treatment of acne. Once-daily application is an advantage in terms of simplicity and adherence to therapy, but the cost is much higher than that of the individual components sold separately; this may create a barrier to adherence.

Apr 15, 2011 Issue
Alvimopan (Entereg) for the Treatment of Postoperative Ileus
Use of alvimopan should be restricted to patients at a higher risk of postoperative ileus following abdominal surgeries, such as hospitalized patients undergoing bowel resection with primary anastomosis. It is an expensive option with limited indications; head-to-head studies with similar agents are needed. Alvimopan is not available for the treatment of nonhospitalized patients.

Feb 15, 2011 Issue
Guanfacine (Intuniv) for Attention-Deficit/Hyperactivity Disorder
Guanfacine is an effective short-term treatment option for ADHD in children six to 12 years of age. Sedation is a marked problem in many children. Patients should take the medication daily to avoid adverse effects that occur with abrupt discontinuation or when the guanfacine is restarted.

Dec 15, 2010 Issue
Bivalent HPV Recombinant Vaccine (Cervarix) for the Prevention of Cervical Cancer
Cervarix is effective in preventing known cytologic and histologic precursors of cervical cancer, although, as with Gardasil, it has not been shown to decrease rates of cervical cancer. This protection has been shown to last for six years, but it is unclear if a booster dose is needed.

Oct 15, 2010 Issue
Milnacipran (Savella) for Fibromyalgia
Milnacipran can decrease the overall pain scores and improve symptoms of fibromyalgia. Safety in patients with severe comorbid medical and psychiatric conditions is unknown because these groups of patients were excluded from the study.

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