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December, 2003 (Issue 16)   | |
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 | Diet, Drugs and Surgery for Weight Loss p.101 |
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Superseded by Treatment Guidelines "Diet, Drugs and Surgery for Weight Loss" - Issue 68, April 2008
The latest definitions of overweight and obesity are based on body mass index (BMI). The BMI is calculated by dividing the weight in kilograms by the square of the height in meters (kg/m2). More than half of American adults are considered overweight with a BMI of ≥25, and about one third are obese with a BMI of ≥30. All ages seem to be affected; the proportion of children and adolescents who are overweight has more than doubled in the past 25 years. There is no lack of effort to treat obesity: drugs, diets and programs to change lifestyle are the basis for a large and flourishing industry. The frequent failure of diet and drug treatment sometimes leads to recommendations for surgery, usually restricted to those with a BMI ≥40. | |
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| November, 2003 (Issue 15) | top |
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| Drugs for Allergic Disorders p.93 |
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Superseded by Treatment Guidelines "Drugs for Allergic Disorders" - Issue 60, August 2007
Allergic rhinitis, allergic conjunctivitis, atopic dermatitis, urticaria and anaphylaxis, along with asthma (reviewed in Treatment Guidelines 2002; 1:7 and not included here), have increased in prevalence during the past 30 years and are now epidemic worldwide, especially in industrialized countries. Many safe and effective drugs are currently available for prevention and relief of symptoms in these disorders, but pharmacological treatment alone may not be sufficient. Patients should also be instructed to avoid specific allergens or environmental conditions that trigger their symptoms. Allergen-specific immunotherapy, parenteral administration of gradually increasing doses of the allergen ("allergy shots"), has been effective in allergic rhinitis, allergic conjunctivitis and allergic asthma, and also in prevention of anaphylaxis triggered by stings from bees, yellow jackets, hornets and wasps. It has not been effective in food allergy, atopic dermatitis or urticaria. | |
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| October, 2003 (Issue 14) | |
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| Infertility occurs in about 15% of couples. About one third of infertility is due to problems with ovulation or an anatomic abnormality of the fallopian tube or peritoneum, such as scarring, adhesions or endometriosis. Another third is due to a male infertility factor, most commonly insufficient sperm production or abnormal motility or morphology. The remaining third is unexplained. In older women unexplained infertility is probably caused by diminished quality and quantity of oocytes, decreased implantation and spontaneous pregnancy wastage. | |
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| September, 2003 (Issue 13) | top |
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| The choice of drugs for treatment of pneumonia depends on the most likely pathogens causing the infection and local antimicrobial resistance patterns. Factors such as severity of illness, presence of co-morbid conditions and whether the infection is community or hospital-acquired also need to be considered. | |
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| August, 2003 (Issue 12) | |
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| Drugs For Lipid Disorders p.77 |
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Superseded by Treatment Guidelines "Drugs for Lipids" - Issue 31, March 2005
Drugs that lower low-density lipoprotein (LDL) cholesterol concentrations can prevent formation, slow progression and cause regression of atherosclerotic lesions, and also improve vasodilatation. In controlled trials in patients with coronary disease, they have reduced mortality by 30% to 40%. Lipid-regulating drugs must be taken indefinitely; when they are stopped, plasma lipid levels return to pretreatment levels in 2-3 weeks. | |
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| July, 2003 (Issue 11) | top |
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| Drugs for Psychiatric Disorders p.69 |
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| June, 2003 (Issue 10) | |
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| Tobacco dependence is a chronic illness that may require pharmacological treatment (MC Fiore et al, JAMA 2000; 283:3244; DPL Sachs in JE Hodgkin et al, eds, Pulmonary Rehabilitation: Guidelines to Success, 3rd ed, Philadelphia; Lippincott Williams & Wilkins, 2000, page 261). | |
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| Drugs for Epilepsy p.57 |
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Superseded by Treatment Guidelines "Drugs for Epilepsy" - Issue 70, June 2008
Treatment of epilepsy should begin with a single drug, increasing the dosage gradually until seizures are controlled or adverse effects become unacceptable. If seizures continue and further dosage increases appear inadvisable because of adverse effects, most Medical Letter consultants generally prescribe at least one and sometimes a second alternative drug as monotherapy before considering use of two drugs at the same time. Most antiepileptic drugs initially approved by the FDA only for adjunctive therapy are probably also effective as monotherapy. Many of the drugs used to treat epilepsy interact with each other (see table beginning on page 63) and with other drugs; for interactions with other drugs, see The Medical Letter Handbook of Adverse Drug Interactions, 2003. The treatment of status epilepticus is not included here. | |
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| April, 2003 (Issue 8) | |
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| Drugs for Treatment of Heart Failure p.53 |
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| March, 2003 (Issue 7) | top |
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| The tables in this article list drugs used for treatment of cancer in the USA and Canada and their major adverse effects. The choice of drugs in Table I is based on the opinions of Medical Letter consultants. Some drugs are listed for indications for which they have not been approved by the US Food and Drug Administration. In some cases, such as elderly patients or those with many co-morbid illnesses, the regimen of choice might not be suitable. For many of the cancers listed, surgery and/or radiation therapy may be the treatment of choice or may also be part of the management. Anticancer drugs and their adverse effects are listed in Table II on page 46. A partial list of brand names appears on page 52. | |
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| February, 2003 (Issue 6) | |
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| Drugs for Hypertension p.33 |
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| January, 2003 (Issue 5) | top |
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| Drugs for Rheumatoid Arthritis p.25 |
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Superseded by Treatment Guidelines "Drugs for Rheumatoid Arthritis" - Issue 81, May 2009
Many different drugs are now used to treat rheumatoid arthritis. Nonsteroidal anti-inflammatory drugs (NSAIDs), listed in the table on page 26, have analgesic and anti-inflammatory effects, but may not affect the disease process. Corticosteroids can provide rapid relief of joint symptoms and control of systemic manifestations, but chronic use is associated with many complications. The "disease-modifying" anti-rheumatic drugs (DMARDs), listed on page 29, have no immediate analgesic effects, but can control symptoms and may delay progression of the disease (American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines, Arthritis Rheum 2002; 46:328). Interactions of anti-rheumatic drugs with other drugs are listed in The Medical Letter Handbook of Adverse Drug Interactions, 2003. | |
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| The Treatment Guidelines article on Drugs for Rheumatoid Arthritis (Vol. 1, January 2003) has an error on page 28. The paragraph on pregnancy should read: Use of NSAIDs during pregnancy has been associated with premature closure of the ductus arteriosus in the fetus and persistent pulmonary hypertension in the newborn (MA Alano et al, Pediatrics 2001; 107:519). These effects appear to be uncommon if the NSAID is stopped 6 to 8 weeks before delivery (M Ostensen and H Ostensen, J Rheumatol 1996; 23:1045). This correction has been made in the web version of the issue. | |
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