Matching articles for "naloxone"
In Brief: A New OTC Naloxone Nasal Spray (RiVive)
The Medical Letter on Drugs and Therapeutics • March 18, 2024; (Issue 1698)
The FDA has approved RiVive (Harm Reduction
Therapeutics), a 3-mg naloxone nasal spray, as
an over-the-counter (OTC) product for emergency
treatment of opioid overdose. Two 4-mg naloxone
nasal spray...
The FDA has approved RiVive (Harm Reduction
Therapeutics), a 3-mg naloxone nasal spray, as
an over-the-counter (OTC) product for emergency
treatment of opioid overdose. Two 4-mg naloxone
nasal spray formulations, Narcan and one of its
generics, were approved for OTC sale in 2023.
Nalmefene Nasal Spray (Opvee) for Reversal of Opioid Overdose
The Medical Letter on Drugs and Therapeutics • October 16, 2023; (Issue 1687)
The FDA has approved an intranasal formulation of
the opioid antagonist nalmefene (Opvee – Indivior) for
emergency treatment of known or suspected opioid
overdose in persons ≥12 years old. Nalmefene,...
The FDA has approved an intranasal formulation of
the opioid antagonist nalmefene (Opvee – Indivior) for
emergency treatment of known or suspected opioid
overdose in persons ≥12 years old. Nalmefene, which
is available by prescription, is the second opioid
antagonist to become available as a nasal spray
for this indication; the first was naloxone, which is
now available for sale over the counter (Narcan, and
generic). Other nasal spray formulations of naloxone
and injectable formulations of nalmefene and
naloxone are available by prescription (see Table 2).
Addendum: Over-the-Counter Narcan Nasal Spray
The Medical Letter on Drugs and Therapeutics • October 2, 2023; (Issue 1686)
Since the publication of our articles entitled Drugs for
Opioid Use Disorder and In Brief: Over-the-Counter
Narcan Nasal Spray earlier this year, Narcan (Emergent),
a nasal spray that delivers 4 mg of the...
Since the publication of our articles entitled Drugs for
Opioid Use Disorder and In Brief: Over-the-Counter
Narcan Nasal Spray earlier this year, Narcan (Emergent),
a nasal spray that delivers 4 mg of the opioid antagonist
naloxone, has become available for sale over the counter
(OTC). According to the manufacturer, the retail price for
a box containing 2 doses is $44.99. Some insurance
companies have announced plans to cover OTC
purchase of the drug for their members.
Comparison Table: Some Drugs for Maintenance Treatment of Opioid Use Disorder (online only)
The Medical Letter on Drugs and Therapeutics • September 4, 2023; (Issue 1684)
...
View Comparison Table: Some Drugs for Maintenance Treatment of Opioid Use Disorder
Drugs for Opioid Use Disorder
The Medical Letter on Drugs and Therapeutics • September 4, 2023; (Issue 1684)
Opioid use disorder is a chronic, relapsing disease with
physical and psychiatric components. It is associated
with economic hardship, social isolation, incarceration,
increased rates of blood-borne...
Opioid use disorder is a chronic, relapsing disease with
physical and psychiatric components. It is associated
with economic hardship, social isolation, incarceration,
increased rates of blood-borne infections such as HIV
and viral hepatitis, adverse pregnancy outcomes, and
increased mortality. According to the NIH, there were
80,411 deaths involving an opioid in the US in 2021,
more than in any previous year. Several guidelines on
the management of opioid use disorder are available;
all recommend maintenance pharmacotherapy as the
standard of care.
In Brief: Over-the-Counter Narcan Nasal Spray
The Medical Letter on Drugs and Therapeutics • May 1, 2023; (Issue 1675)
The FDA has approved the over-the-counter (OTC)
sale of Narcan (Emergent), a nasal spray that delivers
4 mg of the opioid antagonist naloxone. Narcan nasal
spray has been available by prescription since...
The FDA has approved the over-the-counter (OTC)
sale of Narcan (Emergent), a nasal spray that delivers
4 mg of the opioid antagonist naloxone. Narcan nasal
spray has been available by prescription since 2015
for emergency treatment of opioid overdose. Generic
formulations of Narcan have also been approved; the
manufacturers of these products will be required to
switch them to OTC status and amend their labeling
accordingly. Kloxxado, an 8-mg naloxone nasal
spray, remains available only by prescription.
Opioids for Pain
The Medical Letter on Drugs and Therapeutics • December 12, 2022; (Issue 1665)
A new CDC guideline for prescribing opioids for pain
recently became available. Nonopioid drugs for pain
were reviewed in a previous...
A new CDC guideline for prescribing opioids for pain
recently became available. Nonopioid drugs for pain
were reviewed in a previous issue.
Nalmefene Returns for Reversal of Opioid Overdose
The Medical Letter on Drugs and Therapeutics • September 5, 2022; (Issue 1658)
The FDA has approved a generic injectable formulation
of the opioid antagonist nalmefene (Purdue) for the
management of known or suspected opioid overdose.
Revex, the reference product, was withdrawn from...
The FDA has approved a generic injectable formulation
of the opioid antagonist nalmefene (Purdue) for the
management of known or suspected opioid overdose.
Revex, the reference product, was withdrawn from the
market in 2008 for commercial reasons.
Zimhi - A Higher-Dose Injectable Naloxone for Opioid Overdose
The Medical Letter on Drugs and Therapeutics • April 18, 2022; (Issue 1648)
The FDA has approved a higher-dose injectable
formulation of the opioid antagonist naloxone
(Zimhi – Adamis) for emergency treatment of opioid
overdose. A single IM or SC injection of the new
formulation...
The FDA has approved a higher-dose injectable
formulation of the opioid antagonist naloxone
(Zimhi – Adamis) for emergency treatment of opioid
overdose. A single IM or SC injection of the new
formulation delivers 5 mg of naloxone; injectable
formulations that deliver 0.4 mg or 2 mg of the drug
have been available for years. Naloxone is also
available in intranasal formulations for the same
indication (see Table 1).
In Brief: Higher-Dose Naloxone Nasal Spray (Kloxxado) for Opioid Overdose
The Medical Letter on Drugs and Therapeutics • September 20, 2021; (Issue 1633)
The FDA has approved a higher-dose intranasal
naloxone formulation (Kloxxado – Hikma) for
emergency treatment of opioid overdose. A single
spray of the new formulation delivers 8 mg of
naloxone; a...
The FDA has approved a higher-dose intranasal
naloxone formulation (Kloxxado – Hikma) for
emergency treatment of opioid overdose. A single
spray of the new formulation delivers 8 mg of
naloxone; a formulation that delivers 4 mg per spray
(Narcan) was approved in 2015.
Drugs Past Their Expiration Date
The Medical Letter on Drugs and Therapeutics • July 27, 2020; (Issue 1603)
Healthcare providers are often asked if drugs can
be used past their expiration date. Because of legal
restrictions and liability concerns, manufacturers do
not sanction such use and usually do not...
Healthcare providers are often asked if drugs can
be used past their expiration date. Because of legal
restrictions and liability concerns, manufacturers do
not sanction such use and usually do not comment
on the safety or effectiveness of their products beyond
the date on the label. Since our last article on this
subject, more data have become available.
Expanded Table: Some Drugs for Management of Opioid Withdrawal Symptoms (online only)
The Medical Letter on Drugs and Therapeutics • August 27, 2018; (Issue 1554)
...
View Expanded Table: Some Drugs for Management of Opioid Withdrawal Symptoms
Lofexidine (Lucemyra) for Opioid Withdrawal
The Medical Letter on Drugs and Therapeutics • July 16, 2018; (Issue 1551)
The FDA has approved lofexidine (Lucemyra – US
WorldMeds/Salix), a centrally acting alpha2 receptor
agonist, to manage withdrawal symptoms in adults
abruptly stopping opioid use. Available in the UK...
The FDA has approved lofexidine (Lucemyra – US
WorldMeds/Salix), a centrally acting alpha2 receptor
agonist, to manage withdrawal symptoms in adults
abruptly stopping opioid use. Available in the UK since
1992, lofexidine is the first nonopioid to be approved
in the US for management of opioid withdrawal
symptoms. Clonidine (Catapres, and generics), another
central alpha2 receptor agonist, has been used off-label
for this indication for many years.
Opioids for Pain
The Medical Letter on Drugs and Therapeutics • April 9, 2018; (Issue 1544)
Use of nonopioid drugs for pain was reviewed in a
previous issue. For many types of moderate to severe acute pain, acetaminophen and/or an NSAID may be as effective as an opioid. Immediate-release formulations...
Use of nonopioid drugs for pain was reviewed in a
previous issue. For many types of moderate to severe acute pain, acetaminophen and/or an NSAID may be as effective as an opioid. Immediate-release formulations of full opioid agonists should generally be used for acute pain that is severe enough to require treatment with an opioid. Use of extended-release or long-acting opioid formulations initially and treatment durations >1 week have been associated with an increased risk of unintended long-term use.
Once-Monthly Subcutaneous Buprenorphine (Sublocade) for Opioid Use Disorder
The Medical Letter on Drugs and Therapeutics • February 26, 2018; (Issue 1541)
The FDA has approved a subcutaneous (SC)
extended-release formulation of the mu-opioid
receptor partial agonist and kappa-opioid receptor
antagonist buprenorphine (Sublocade – Indivior)
for once-monthly...
The FDA has approved a subcutaneous (SC)
extended-release formulation of the mu-opioid
receptor partial agonist and kappa-opioid receptor
antagonist buprenorphine (Sublocade – Indivior)
for once-monthly treatment of moderate to severe
opioid use disorder. Sublocade is the first injectable
buprenorphine product to be approved in the US.
Buprenorphine is also available in sublingual
formulations with or without the opioid antagonist
naloxone, in a buccal formulation with naloxone, and
as a subdermal implant (Probuphine).
Drugs for Opioid Use Disorder
The Medical Letter on Drugs and Therapeutics • June 5, 2017; (Issue 1522)
Opioid use disorder is a chronic, relapsing disease with both physical and psychiatric components. It is
associated with economic hardship, social isolation,
incarceration, increased rates of...
Opioid use disorder is a chronic, relapsing disease with both physical and psychiatric components. It is
associated with economic hardship, social isolation,
incarceration, increased rates of blood-borne
infections such as HIV and viral hepatitis, adverse
pregnancy outcomes, and increased mortality.
According to the CDC, there were 33,091 deaths
related to opioid overdose in the US in 2015, more
than in any previous year. Several guidelines on the
management of opioid use disorder have recently
been published.
Buprenorphine Implants (Probuphine) for Opioid Dependence
The Medical Letter on Drugs and Therapeutics • July 18, 2016; (Issue 1499)
The FDA has approved subdermal implants of the partial
opioid agonist buprenorphine (Probuphine – Titan) for
maintenance treatment of opioid dependence in patients
stabilized on low to moderate doses of...
The FDA has approved subdermal implants of the partial
opioid agonist buprenorphine (Probuphine – Titan) for
maintenance treatment of opioid dependence in patients
stabilized on low to moderate doses of transmucosal
buprenorphine. Probuphine was designed to provide
continuous low levels of buprenorphine for 6 months
and to safeguard against illicit use of the drug.
A New Abuse-Deterrent Opioid - Xtampza ER
The Medical Letter on Drugs and Therapeutics • June 20, 2016; (Issue 1497)
The FDA has approved Xtampza ER (Collegium),
a new extended-release, abuse-deterrent capsule
formulation of oxycodone, for management of pain
severe enough to require daily, around-the-clock,
long-term...
The FDA has approved Xtampza ER (Collegium),
a new extended-release, abuse-deterrent capsule
formulation of oxycodone, for management of pain
severe enough to require daily, around-the-clock,
long-term opioid treatment and for which alternative
treatment options are inadequate.
Clarification: Half-Life of Heroin
The Medical Letter on Drugs and Therapeutics • February 29, 2016; (Issue 1489)
A reader expressed concern that a statement in our article Naloxone (Narcan) Nasal Spray for Opioid Overdose (Med Lett Drugs Ther 2016; 58:1) might be misleading. We stated that heroin has a half-life of 2-6...
A reader expressed concern that a statement in our article Naloxone (Narcan) Nasal Spray for Opioid Overdose (Med Lett Drugs Ther 2016; 58:1) might be misleading. We stated that heroin has a half-life of 2-6 minutes, which is correct, but heroin is a prodrug that is rapidly metabolized to 6-acetylmorphine and morphine. The risk of respiratory depression is related to those active metabolites, and it may persist well beyond the clearance of heroin from the blood.
Naloxone (Narcan) Nasal Spray for Opioid Overdose
The Medical Letter on Drugs and Therapeutics • January 4, 2016; (Issue 1485)
The recent increase in deaths due to overdose of
heroin and prescription opioids in the US has renewed
interest in the opioid antagonist naloxone, particularly
in making it available to first responders and...
The recent increase in deaths due to overdose of
heroin and prescription opioids in the US has renewed
interest in the opioid antagonist naloxone, particularly
in making it available to first responders and to
relatives and close friends of persons using heroin or
taking prescription opioids. IV or IM administration
by healthcare professionals is preferred, but
peripheral venous access may be difficult to obtain
in IV drug abusers, and exposure to their blood may
be hazardous.
Abuse-Deterrent Opioid Formulations
The Medical Letter on Drugs and Therapeutics • August 31, 2015; (Issue 1476)
Development of abuse-deterrent opioid products,
including reformulation of existing products, has
become a priority for drug manufacturers and public
health advocates. Three available opioid...
Development of abuse-deterrent opioid products,
including reformulation of existing products, has
become a priority for drug manufacturers and public
health advocates. Three available opioid formulations,
OxyContin (Purdue), Embeda (Pfizer), and Hysingla ER
(Purdue), now include claims of abuse deterrence in
their package inserts.
Bunavail: Another Buprenorphine/Naloxone Formulation for Opioid Dependence
The Medical Letter on Drugs and Therapeutics • February 2, 2015; (Issue 1461)
The FDA has approved a buccal film formulation of the
partial opioid agonist buprenorphine combined with
the opioid antagonist naloxone (Bunavail – BioDelivery
Sciences) for maintenance treatment of...
The FDA has approved a buccal film formulation of the
partial opioid agonist buprenorphine combined with
the opioid antagonist naloxone (Bunavail – BioDelivery
Sciences) for maintenance treatment of opioid
dependence. Sublingual tablet and film formulations
of the same combination were approved earlier. The
manufacturer of Bunavail claims that the new product
is superior to sublingual formulations because of
the convenience of buccal administration and better
absorption into the blood, permitting use of lower doses.
In Brief: A Naloxone Auto-Injector (Evzio)
The Medical Letter on Drugs and Therapeutics • June 9, 2014; (Issue 1444)
A recent Medical Letter article reported renewed interest in the intranasal administration (off-label) of the opioid antagonist naloxone because of an increase in deaths from opioid overdose in the US.1 Now the...
A recent Medical Letter article reported renewed interest in the intranasal administration (off-label) of the opioid antagonist naloxone because of an increase in deaths from opioid overdose in the US.1 Now the FDA has approved a more practical alternative for emergency treatment of life-threatening opioid overdose in adults and children: a single-dose naloxone auto-injector (Evzio – Kaleo) for intramuscular or subcutaneous use.
Evzio will be available in kits containing two prefilled 0.4-mg auto-injectors with voice guidance and a "trainer" device that also has voice guidance, but does not contain medication or a needle. The manufacturer has not published a price for Evzio to date, but news reports indicate that each kit could cost hundreds of dollars, compared to about $20 for a standard 0.4-mg injectable dose of naloxone, which can be given intranasally.
1. Intranasal naloxone for treatment of opioid overdose. Med Lett Drugs Ther 2014; 56:21.
Download complete U.S. English article
Evzio will be available in kits containing two prefilled 0.4-mg auto-injectors with voice guidance and a "trainer" device that also has voice guidance, but does not contain medication or a needle. The manufacturer has not published a price for Evzio to date, but news reports indicate that each kit could cost hundreds of dollars, compared to about $20 for a standard 0.4-mg injectable dose of naloxone, which can be given intranasally.
1. Intranasal naloxone for treatment of opioid overdose. Med Lett Drugs Ther 2014; 56:21.
Download complete U.S. English article
Intranasal Naloxone for Treatment of Opioid Overdose
The Medical Letter on Drugs and Therapeutics • March 17, 2014; (Issue 1438)
The recent increase in deaths from heroin overdose in
the US has led to renewed interest in the opioid antagonist
naloxone, particularly in making it available as an intranasal
spray to paramedics and...
The recent increase in deaths from heroin overdose in
the US has led to renewed interest in the opioid antagonist
naloxone, particularly in making it available as an intranasal
spray to paramedics and possibly to relatives and
close friends of heroin users. Intravenous (IV) administration
is preferred, but peripheral venous access may
be difficult to obtain in IV drug abusers, and exposure
to their blood may be hazardous.
In Brief: Buprenorphine/Naloxone (Zubsolv) for Opioid Dependence
The Medical Letter on Drugs and Therapeutics • October 14, 2013; (Issue 1427)
A new sublingual tablet formulation of the partial opioid agonist buprenorphine combined with the opioid antagonist naloxone (Zubsolv – Orexo) has been approved by the FDA for maintenance treatment of opioid...
A new sublingual tablet formulation of the partial opioid agonist buprenorphine combined with the opioid antagonist naloxone (Zubsolv – Orexo) has been approved by the FDA for maintenance treatment of opioid dependence. Zubsolv tablets have relatively greater bioavailability than previously approved sublingual film (Suboxone) and sublingual tablet formulations of buprenorphine/naloxone and, according to an open-label survey, they taste better. The new tablets are smaller and dissolve faster than other tablet formulations, and they are individually sealed in child-resistant packaging.1
Buprenorphine is a Schedule III controlled substance that can be prescribed in an office setting by qualified physicians who register with the Substance Abuse and Mental Health Services Administration.2
Zubsolv is available as triangular tablets containing 1.4 mg of buprenorphine and 0.36 mg of naloxone and round tablets containing 5.7 mg of buprenorphine and 1.4 mg of naloxone, which achieve plasma concentrations of buprenorphine equivalent to those with the 2/0.5-mg and 8/2-mg strengths of other buprenorphine/naloxone tablets. A package of Zubsolv 5.7/1.4-mg tablets costs the same ($211) as a box of Suboxone 8/2-mg films. A bottle of generic buprenorphine/naloxone 8/2-mg tablets costs $250.3
1. A Fischer et al. Pharmaceutical and pharmacokinetic characterization of a novel sublingual buprenorphine/naloxone tablet formulation in healthy volunteers. Drug Dev Ind Pharm 2013 Oct 7 (epub).
2. Buprenorphine: an alternative to methadone. Med Lett Drugs Ther 2003; 45:13.
3. Approximate wholesale acquisition cost (WAC) of 30 tablets or films. Source: $ource® Monthly (Selected from FDB MedKnowledge™) October 5, 2013. Reprinted with permission by FDB, Inc. All rights reserved. ©2013. www.fdbhealth.com/policies/drug-pricing-policy. Actual retail prices may be higher.
Download complete U.S. English article
Buprenorphine is a Schedule III controlled substance that can be prescribed in an office setting by qualified physicians who register with the Substance Abuse and Mental Health Services Administration.2
Zubsolv is available as triangular tablets containing 1.4 mg of buprenorphine and 0.36 mg of naloxone and round tablets containing 5.7 mg of buprenorphine and 1.4 mg of naloxone, which achieve plasma concentrations of buprenorphine equivalent to those with the 2/0.5-mg and 8/2-mg strengths of other buprenorphine/naloxone tablets. A package of Zubsolv 5.7/1.4-mg tablets costs the same ($211) as a box of Suboxone 8/2-mg films. A bottle of generic buprenorphine/naloxone 8/2-mg tablets costs $250.3
1. A Fischer et al. Pharmaceutical and pharmacokinetic characterization of a novel sublingual buprenorphine/naloxone tablet formulation in healthy volunteers. Drug Dev Ind Pharm 2013 Oct 7 (epub).
2. Buprenorphine: an alternative to methadone. Med Lett Drugs Ther 2003; 45:13.
3. Approximate wholesale acquisition cost (WAC) of 30 tablets or films. Source: $ource® Monthly (Selected from FDB MedKnowledge™) October 5, 2013. Reprinted with permission by FDB, Inc. All rights reserved. ©2013. www.fdbhealth.com/policies/drug-pricing-policy. Actual retail prices may be higher.
Download complete U.S. English article
Transdermal Buprenorphine (Butrans) for Chronic Pain
The Medical Letter on Drugs and Therapeutics • April 18, 2011; (Issue 1362)
The FDA has approved the partial opioid agonist
buprenorphine in a transdermal formulation (Butrans –
Purdue) for treatment of moderate to severe chronic
pain. Buprenorphine has been available in the US...
The FDA has approved the partial opioid agonist
buprenorphine in a transdermal formulation (Butrans –
Purdue) for treatment of moderate to severe chronic
pain. Buprenorphine has been available in the US for
years in parenteral formulations for pain and in sublingual tablets for opioid dependence.1 Transdermal
buprenorphine has been available in Europe for several
years.2
In Brief: Heat and Transdermal Fentanyl
The Medical Letter on Drugs and Therapeutics • August 10, 2009; (Issue 1318)
Transdermal fentanyl (Duragesic, and others) offers a convenient delivery system for patients with chronic pain1 but it has some drawbacks. One is that exposing the patch to heat, either from an external...
Transdermal fentanyl (Duragesic, and others) offers a convenient delivery system for patients with chronic pain1 but it has some drawbacks. One is that exposing the patch to heat, either from an external source, increased exertion or possibly high fever, could increase release of the drug, which might lead to an overdose and fatal respiratory depression.2 A recent article in the NY Times about this problem may have aroused the concerns of some patients using the patches.3
First approved for marketing by the FDA in 19914, transdermal fentanyl provides continuous delivery of the drug for about 3 days. After application of the patch, a depot of fentanyl forms in the upper layers of the skin. Serum concentrations of the drug increase gradually, reaching a peak (Cmax) in 24-72 hours. According to a pharmacokinetic model mentioned in the labeling, an increase in body temperature to 40°C (104°F) could increase fentanyl serum concentrations by 33%. Local application of heat near or on a fentanyl transdermal patch also increases systemic absorption; in one study, heating the patch during the first 4 hours after application increased maximum serum concentrations nearly three-fold.5 Unintentional increases in systemic fentanyl absorption caused by a heating pad, a warming blanket used during surgery and strenuous exertion have led to respiratory depression in 3 patients.6 No reports of clinical overdosage caused by fever have been published.
Serious adverse events may require removal of the patch and administration of an opioid antagonist such as naloxone (Narcan, and others). Monitoring for hypoventilation or cognitive impairment for at least 24 hours is recommended after removing the patch because fentanyl concentrations decrease slowly (50% decrease in about 17 hours) due to continued systemic absorption from the intracutaneous reservoir.
1. Drugs for pain. Treat Guidel Med Lett 2007; 5:23.
2. FDA Alert 7/15/2005; Update 12/21/2007. Information for healthcare professionals: Fentanyl transdermal system (marketed as Duragesic and generics). Available at www.fda.gov/cder/drug/InfoSheets/HCP/fentanyl_2007HCP.htm. Accessed July 27, 2009.
3. T Brown. Doctors and nurses, still learning. New York Times, April 29, 2009. Available at NYTimes.com. Accessed July 29, 2009.
4. Transdermal fentanyl. Med Lett Drugs Ther 1992; 34:97.
5. MA Ashburn et al. The pharmacokinetics of transdermal fentanyl delivered with and without controlled heat. J Pain 2003; 4:291.
6. KA Carter. Heat-associated increase in transdermal fentanyl absorption. Am J Health Syst Pharm 2003; 60:191.
Download: U.S. English
First approved for marketing by the FDA in 19914, transdermal fentanyl provides continuous delivery of the drug for about 3 days. After application of the patch, a depot of fentanyl forms in the upper layers of the skin. Serum concentrations of the drug increase gradually, reaching a peak (Cmax) in 24-72 hours. According to a pharmacokinetic model mentioned in the labeling, an increase in body temperature to 40°C (104°F) could increase fentanyl serum concentrations by 33%. Local application of heat near or on a fentanyl transdermal patch also increases systemic absorption; in one study, heating the patch during the first 4 hours after application increased maximum serum concentrations nearly three-fold.5 Unintentional increases in systemic fentanyl absorption caused by a heating pad, a warming blanket used during surgery and strenuous exertion have led to respiratory depression in 3 patients.6 No reports of clinical overdosage caused by fever have been published.
Serious adverse events may require removal of the patch and administration of an opioid antagonist such as naloxone (Narcan, and others). Monitoring for hypoventilation or cognitive impairment for at least 24 hours is recommended after removing the patch because fentanyl concentrations decrease slowly (50% decrease in about 17 hours) due to continued systemic absorption from the intracutaneous reservoir.
1. Drugs for pain. Treat Guidel Med Lett 2007; 5:23.
2. FDA Alert 7/15/2005; Update 12/21/2007. Information for healthcare professionals: Fentanyl transdermal system (marketed as Duragesic and generics). Available at www.fda.gov/cder/drug/InfoSheets/HCP/fentanyl_2007HCP.htm. Accessed July 27, 2009.
3. T Brown. Doctors and nurses, still learning. New York Times, April 29, 2009. Available at NYTimes.com. Accessed July 29, 2009.
4. Transdermal fentanyl. Med Lett Drugs Ther 1992; 34:97.
5. MA Ashburn et al. The pharmacokinetics of transdermal fentanyl delivered with and without controlled heat. J Pain 2003; 4:291.
6. KA Carter. Heat-associated increase in transdermal fentanyl absorption. Am J Health Syst Pharm 2003; 60:191.
Download: U.S. English
Pharmaceutical Drug Overdose
The Medical Letter on Drugs and Therapeutics • September 1, 2006; (Issue 49)
Every pharmaceutical drug is a dose-dependent poison. This article describes the clinical presentation and treatment of some dangerous overdoses commonly reported in...
Every pharmaceutical drug is a dose-dependent poison. This article describes the clinical presentation and treatment of some dangerous overdoses commonly reported in adults.
Buprenorphine: An alternative to Methadone
The Medical Letter on Drugs and Therapeutics • February 17, 2003; (Issue 1150)
The FDA has approved the marketing of buprenorphine in sublingual tablets (Reckitt Benckiser) both alone (Subutex) and with naloxone (Suboxone) for treatment of opioid dependence. Previously available only...
The FDA has approved the marketing of buprenorphine in sublingual tablets (Reckitt Benckiser) both alone (Subutex) and with naloxone (Suboxone) for treatment of opioid dependence. Previously available only for parenteral use in treatment of pain (Buprenex, and others), it offers an alternative to methadone (Dolophine, and others), which is now often abused (New York Times, February 9, 2003; page 1). As a schedule III narcotic, buprenorphine will be subject to fewer prescribing restrictions than a schedule II drug such as methadone (MJ Kreek and FJ Vocci, J Subst Abuse Treat 2002; 23:93).w1150a
Acute Reactions to Drugs of Abuse
The Medical Letter on Drugs and Therapeutics • March 4, 2002; (Issue 1125)
Acute toxic reactions to drugs of abuse continue to be important problems. Some patients may have mixed intoxications with complex combinations of signs and...
Acute toxic reactions to drugs of abuse continue to be important problems. Some patients may have mixed intoxications with complex combinations of signs and symptoms.
Acute Reactions to Drugs of Abuse
The Medical Letter on Drugs and Therapeutics • May 10, 1996; (Issue 974)
Acute toxic reactions to drugs of abuse continue to be important problems. Since the last Medical Letter article on this subject (volume 32, page 92, 1990), new reactions and new approaches to treating them...
Acute toxic reactions to drugs of abuse continue to be important problems. Since the last Medical Letter article on this subject (volume 32, page 92, 1990), new reactions and new approaches to treating them have been reported.
Nalmefene - Long-Acting Injectable Opioid Antagonist
The Medical Letter on Drugs and Therapeutics • October 27, 1995; (Issue 960)
Nalmefene (Revex - Ohmeda), an i methylene analog of naltrexone (Trexan), is a long-acting opioid antagonist that has been approved by the US Food and Drug Administration for reversal of postoperative opioid...
Nalmefene (Revex - Ohmeda), an i methylene analog of naltrexone (Trexan), is a long-acting opioid antagonist that has been approved by the US Food and Drug Administration for reversal of postoperative opioid drug effects, including respiratory depression, sedation and hypotension and for management of known or suspected opioid overdose in the emergency department. The only other opioid antagonists available in the USA are naloxone (Narcan), which is also injectable but has a short duration of action, and naltrexone, which has a long duration of action but is marketed only for oral use.
Naltrexone For Alcohol Dependence
The Medical Letter on Drugs and Therapeutics • July 21, 1995; (Issue 953)
Naltrexone (ReVia -DuPont Pharma), a long-acting oral opioid antagonist previously marketed for treatment of opioid dependence under the trade name Trexan, was recently approved by the US Food and Drug...
Naltrexone (ReVia -DuPont Pharma), a long-acting oral opioid antagonist previously marketed for treatment of opioid dependence under the trade name Trexan, was recently approved by the US Food and Drug Administration (FDA) for treatment of alcohol dependence. The new trade name will now also be used for the old indication.
Butorphanol Nasal Spray for Pain
The Medical Letter on Drugs and Therapeutics • November 12, 1993; (Issue 909)
Butorphanol tartrate, a synthetic opioid agonist-antagonist analgesic previously available for injection, is now being marketed as a nasal spray (Stadol-NS - Mead Johnson). The spray was approved by the US...
Butorphanol tartrate, a synthetic opioid agonist-antagonist analgesic previously available for injection, is now being marketed as a nasal spray (Stadol-NS - Mead Johnson). The spray was approved by the US Food and Drug Administration (FDA) for any type of pain for which an opioid analgesic is appropriate, but the manufacturer is emphasizing use for treatment of migraine headache and postoperative pain. Drugs for pain were reviewed in the Medical Letter, volume 35, page 1, January 8, 1993.
Drugs for Acute Spinal Cord Injury
The Medical Letter on Drugs and Therapeutics • August 6, 1993; (Issue 902)
The well-publicized recovery from paralysis of a professional football player has recently focused attention on the growing use of drugs to minimize the effects of spinal cord injury. Methylprednisolone...
The well-publicized recovery from paralysis of a professional football player has recently focused attention on the growing use of drugs to minimize the effects of spinal cord injury. Methylprednisolone sodium succinate (Solu-Medrol - Upjohn), commercially available in the USA for intravenous treatment of transplant rejection and various inflammatory and auto-immune disorders, and GM-1 ganglioside, commercially available in Italy (Sygen - Fidia) but not in the USA, are now widely used in patients with spinal cord injury.
Laser Coronary Angioplasty
The Medical Letter on Drugs and Therapeutics • January 25, 1991; (Issue 836)
Percutaneous transluminal coronary angioplasty (PTCA), in which a balloon catheter distends the vessel at the site of obstruction (Medical Letter, 25:97, 1983), is now an established therapeutic option for...
Percutaneous transluminal coronary angioplasty (PTCA), in which a balloon catheter distends the vessel at the site of obstruction (Medical Letter, 25:97, 1983), is now an established therapeutic option for treatment of patients with coronary artery disease, especially those with single-vessel disease. Major problems related to PTCA include acute occlusion during the procedure (usually caused by dissection), restenosis at the site of angioplasty, and inability to treat complete occlusions and long or ostial lesions. Some cardiologists have tried using lasers during PTCA to deal with these problems.
Dezocine
The Medical Letter on Drugs and Therapeutics • October 19, 1990; (Issue 829)
Dezocine (Dalgan - Astra), a new synthetic opioid agonist/antagonist structurally related to pentazocine (Talwin), was recently approved for parenteral use as an analgesic by the US Food and Drug...
Dezocine (Dalgan - Astra), a new synthetic opioid agonist/antagonist structurally related to pentazocine (Talwin), was recently approved for parenteral use as an analgesic by the US Food and Drug Administration.
Acute Reactions to Drugs of Abuse
The Medical Letter on Drugs and Therapeutics • October 5, 1990; (Issue 828)
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Drugs That Cause Pulmonary Toxicity
The Medical Letter on Drugs and Therapeutics • September 21, 1990; (Issue 827)
Some commonly used systemic drugs that may cause pulmonary toxicity are listed in the table below. These adverse effects may sometimes be difficult to distinguish from the underlying disease (JAD Cooper, Jr...
Some commonly used systemic drugs that may cause pulmonary toxicity are listed in the table below. These adverse effects may sometimes be difficult to distinguish from the underlying disease (JAD Cooper, Jr et al, Am Rev Respir Dis, 133:321, 488, 1986). Pulmonary effects that are part of a generalized reaction or are indirect effects of drugs - on respiratory muscles, for example, or on the immune system - are not included here.