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This is a bimonthly publication targeting identified problematic therapeutic issues in a brief, simple and practical manner.
The process leading up to publication involves a rigorous, systematic literature review by different working groups of the Therapeutics Initiative, the creation of a draft which is circulated for comment among a sizeable group of over 100 local, national and international specialists with expertise in the particular therapeutic area and the commission of original artwork/illustration.
The message is developed collaboratively by different working groups of the Therapeutics Initiative. The current Editor in Chief is Dr. Tom Perry, Chair of the Education Working Group of the Therapeutics Initiative.
Therapeutics Letters on common therapies have been regularly published since 1994 and distributed free of charge to clinicians, patients, and policymakers to increase awareness and improve prescription habits.
Contents
- Letter 140. What to do about borderline hyperglycemia?Published: December 2022.
- Letter 139. How well do you know your dopamine antagonists?Published: October 2022.
- Letter 138. Reducing prescribing cascadesPublished: August 2022.
- Letter 137. Physical activity is medicine: Prescribe itPublished: June 2022.
- Letter 136. How do YOU respond to Conflicts of Interest?Published: April 2022.
- Letter 135. Empiric Antibiotic Therapy for Uncomplicated Lower Urinary Tract InfectionsPublished: February 2022.
- Diagnose by symptoms, not tests
- Culture seldom required
- Treat with regard to regional resistance patterns
- Nitrofurantoin for 5–7 days best for uncomplicated UTI in BC
- What is the alternative for patients unable to take nitrofurantoin?
- Antibiotic treatment failure
- Non-antibiotic treatment
- Conclusions
- References
- Letter 134. Finding the lowest effective dose for non-opioid analgesicsPublished: December 2021.
- Letter 133. Primary hypertension therapy: after thiazide, an ACEI or an ARB?Published: October 2021.
- Background
- Optimal first line treatment: thiazides and thiazide-like diuretics
- Optimal second line treatment: ACEIs over ARBs
- Are higher doses superior?
- Choose within a class by price
- Generic ramipril is the least expensive ACEI in BC
- For an ARB choose generic candesartan or telmisartan
- Conclusions
- References
- Letter 132. Rethinking: Medication AdherencePublished: August 2021.
- Letter 131. Tramadol: Where do we go from here?Published: June 2021.
- Letter 130. Evidence for statins in people over 70Published: April 2021.
- Letter 129. Mirtazapine: Update on efficacy, safety, dose responsePublished: February 2021.
- Letter 128. Drug Safety Advisories: A need for international coordinationPublished: December 2020.
- Letter 127. Audit and Feedback: Personal Prescribing PortraitPublished: August 2020.
- Letter 126. Serious harms with long-term PPI use in older adultsPublished: April 2020.
- Letter 125. Can prescribers avoid contributing to opioid use disorder?Published: February 2020.
- Letter SE. Pill splitting: Making the most of meds in a time of needPublished: March 2020.
- Clinical vignette
- Could tablet splitting help maintain drug supply during the pandemic?
- Advantages of pill splitting
- When not to split pills
- Modified release tablets
- Pill splitting is not for everyone
- What is the evidence on the benefits and safety of pill splitting?
- Can a “drug holiday” or deprescribing be considered?
- Writing the prescription
- Conclusions
- References
- Letter 124. Your views of the Therapeutics Initiative: 2019 SurveyPublished: December 2019.
- Letter 123. Biosimilars or Biologics: What’s the difference?Published: October 2019.
- Letter 122. Twenty-Five Pearls from 25 years (part 2)Published: August 2019.
- 14. The majority of new drugs do NOT represent a major advantage when compared to available alternatives
- 15. Risk assessment tools need to be studied in RCTs
- 16. Health care professionals must know how to critique and verify drug information in news stories
- 17. Better benefit and harm evidence is needed before long-term CNS stimulants can be recommended for treatment of ADHD in children
- 18. Statins do NOT have a proven net health benefit in primary prevention and their role in this setting should be reconsidered
- 19. There are no clinically meaningful benefits of bisphosphonates in postmenopausal women with NO prior fracture or vertebral compression
- 20. Seven steps to become adept at deprescribing
- 21. Most commonly used surrogate markers have not been proven to be consistently predictive of morbidity and mortality
- 22. Lower blood pressure targets have not been shown to have a net health benefit
- 23. Independent analysis of Study 329 demonstrated serious harms and a lack of efficacy for acute and longer-term use of paroxetine and imipramine for adolescents with major depression
- 24. Growing evidence that the ‘glucocentric’ drug management approach for type 2 diabetes is misguided
- 25. Compared to placebo the Shingrix vaccine reduced the incidence of herpes zoster
- Letter 121. Twenty-Five Pearls from 25 years (part 1)Published: July 2019.
- 1. Thiazides are clearly the drug of first choice for the treatment of uncomplicated hypertension
- 2. In many clinical settings start with a dose that is ¼ to ½ the manufacturer’s recommended starting dose
- 3. Until randomized trials testing menopausal hormone therapy are completed, long-term therapy decisions have to be made in the face of uncertainty, balancing the potential benefits and risks in individual patients
- 4. Fewer physicians and patients will choose a therapy when the data is presented as absolute risk reduction (ARR) and number needed to treat (NNT) than if it is presented as relative risk (RR) or relative risk reduction (RRR)
- 5. Patients with “mild” symptoms of benign prostatic hyperplasia (BPH) should be reassured and do not need any treatment
- 6. Exercise and weight loss are effective in preventing and treating type 2 diabetes
- 7. For primary prevention the likelihood of benefit is considerably less than for secondary prevention
- 8. Since almost all clinical data about celecoxib remain unpublished and is therefore unavailable for critical appraisal and assessment, it is impossible for the TI to provide timely unbiased information to you and other health professionals
- 9. COX-2 selective NSAIDS were associated with the same incidence of serious adverse events as non-selective NSAIDS
- 10. Esomeprazole at equivalent doses offers no therapeutic advantage over other PPIs (including omeprazole)
- 11. Because of the unfavourable harm to benefit balance for antidepressants in individuals less than 19 years of age, first line therapy is multiple supportive interventions: sleep hygiene, exercise, regular dietary patterns, consistent parenting and practical problem-solving regarding schooling and life stressors
- 12. Product monographs do not adequately inform clinicians
- 13. Donepezil has not been demonstrated to improve outcomes of importance to patients and caregivers (e.g. institutionalization or disability)
- Letter 120. Routine VTE prophylaxis: Is there a net health benefit?Published: June 2019.
- Letter 119. Epinephrine autoinjectors available in CanadaPublished: May 2019.
- Letter 118. Trends in utilization of proton pump inhibitors in British ColumbiaPublished: March 2019.
- Letter 117. Gabapentin and pregabalin: Are high doses justified?Published: January 2019.
- Letter 116. New drug for cystic fibrosis: Regulatory approval, clinical uncertainty?Published: December 2018.
- Letter 115. Cannabinoids for Chronic PainPublished: November 2018.
- Letter 114. Shingrix: A New Vaccine for ShinglesPublished: October 2018.
- Letter 113. How well do you know your anticholinergic (antimuscarinic) drugs?Published: August 2018.
- Letter 112. Antidepressant Withdrawal SyndromePublished: June 2018.
- Letter 111. Deprescribing Proton Pump InhibitorsPublished: April 2018.
- Letter 110. Stimulants for ADHD in children: RevisitedPublished: February 2018.
- Letter 109. Inhaled long acting β2 agonists for COPDPublished: December 2017.
- Objective
- Methods
- Results
- Risk of bias
- TORCH trial
- Clinical implications
- Other systematic reviews
- Conclusions
- References
- Risk of bias assessment: Formoterol and Arformoterol vs. Placebo review
- Risk of bias assessment: Salmeterol vs. Placebo review
- Comparison 1: Formoterol and Arformoterol vs Placebo (dose ranging efficacy)
- Comparison 2: Salmeterol versus placebo (dose ranging efficacy)
- Letter 108. Drugs to avoidPublished: October 2017.
- Letter 107. EMPA-REG OUTCOME Trial What does it mean?Published: August 2017.
- Letter 106. Using Best Evidence for the Management of HypertensionPublished: June 2017.
- What is the evidence for drug treatment of moderate to severe hypertension (>160/100) in people ≥ 60 years?
- What is the evidence for drug treatment of hypertension in people aged 18 to 59?
- What is the evidence for drugs for mild hypertension (140–159/90–99)?
- If drug therapy is appropriate, what drug class is the best one to try first?
- What is the optimal target blood pressure?
- Conclusions
- References
- Letter 105. Is cyclobenzaprine useful for pain?Published: April 2017.
- Letter 104. Does Medication Review improve health?Published: February 2017.
- Letter 103. Is the current ‘glucocentric’ approach to management of type 2 diabetes misguided?Published: December 2016.
- Letter 102. Indacaterol for chronic obstructive pulmonary diseasePublished: October 2016.
- Letter 101. Study 329: Why is it so important?Published: August 2016.
- Letter 100. Questioning the basis of approval for non-insulin glucose lowering drugsPublished: June 2016.
- Letter 99. Comparative effectiveness of proton pump inhibitorsPublished: April 2016.
- Are there any important differences between the different drugs in the class?
- Comparative trials of PPIs in adult patients with symptomatic GERD
- Comparative trials of PPIs in adult patients with symptomatic PUD
- Overall Risk of Bias assessment
- Applicability of evidence
- What proportion of patients treated with PPIs will experience benefit of therapy?
- Comparative overall safety of PPI
- Are there differences in cost of PPIs?
- Conclusions
- References
- Letter 98. Does SPRINT change our approach to blood pressure targets?Published: February 2016.
- Letter 97. Intravenous (IV) iron for severe iron deficiencyPublished: December 2015.
- Letter 96. Benefits and harms of drugs for “neuropathic” painPublished: October 2015.
- Letter 95. Antipsychotics should not be used for non-psychotic depressionPublished: August 2015.
- Letter 94. Dual antiplatelet therapy: net health benefit or harm?Published: June 2015.
- Letter 93. Are claims for newer drugs for overactive bladder warranted?Published: February 2015.
- Letter 92. The limitations and potential hazards of using surrogate markersPublished: December 2014.
- 1. Does “worsening” of a surrogate marker reliably indicate an increased risk of morbidity and mortality?
- 2. Does “improving” a specific surrogate marker lead to less morbidity and mortality?
- 3. Do benefits of using surrogate markers as targets for drug therapy outweigh the harms?
- 4. Is it useful to employ surrogate marker values in risk prediction tools?
- Conclusion
- References
- Letter 91. Is prescribing information from sales representatives balanced?Published: September 2014.
- Letter 90. Reducing polypharmacy: A logical approachPublished: July 2014.
- 1. Re-evaluate the goals of therapy
- 2. Apply absolute risk differences
- 3. Consider simple pharmacology and physiology
- 4. Avoid unnecessary drug costs
- 5. Reassess the ongoing value of individual and combination drugs
- 6. Use common sense and the Golden Rule
- 7. Aim to stop at least 1 drug and monitor
- Graphs
- References
- Letter 89. Statins proven and associated harmsPublished: May 2014.
- Letter 88. Filling the Evidence Gap Pragmatic Randomized Controlled Trials in British ColumbiaPublished: August 2013.
- Letter 87. High dose versus standard dose statins in stable coronary heart diseasePublished: August 2012.
- Letter 86. Your opinions of the Therapeutics Initiative: The 2011 SurveyPublished: June 2012.
- Letter 85. Clinical Pearls from PrescrirePublished: March 2012.
- Arterial hypertension: don’t expose patients to the adverse effects of aliskiren (Rasilez
- Drugs for Alzheimer’s disease: best avoided (Reassessment)
- Escitalopram (Cipralex: torsades de pointes
- Gabapentin (Neurontin and pregabalin (Lyrica: abuse and addiction
- Migraine attacks: acetaminophen (Tylenol first
- Varenicline (Champix: aggression and homicidal ideation
- References
- Letter 84. A Systematic Review of the Harms of BisphosphonatesPublished: December 2011.
- Letter 83. A Systematic Review of the Efficacy of BisphosphonatesPublished: October 2011.
- Letter 82. Clinical Hypertension Pearls from The Cochrane LibraryPublished: August 2011.
- Letter 81. Self-Monitoring of Blood Glucose in Type 2 DiabetesPublished: June 2011.
- Letter 80. Dabigatran for atrial fibrillation Why we can not rely on RE-LYPublished: March 2011.
- Letter 79. Is use of quetiapine for sleep evidence-based?Published: December 2010.
- Letter 78. Bisphosphonates: Do they prevent or cause bone fractures?Published: August 2010.
- Letter 77. Do statins have a role in primary prevention? An updatePublished: April 2010.
- Letter 76. Are antidepressants safe in pregnancy? A focus on SSRIsPublished: February 2010.
- Are pregnant women at higher risk for depression?
- Does depression in pregnancy lead to harm?
- What are the benefits to the mother of SSRIs in pregnancy?
- What are the benefits to the infant of SSRIs in pregnancy?
- What are the harms to the fetus of SSRIs in pregnancy?
- Non-drug treatments
- Conclusions and clinical implications
- References
- Letter 75. Gabapentin for pain: New evidence from hidden dataPublished: December 2009.
- Letter 74. Increasing use of newer antipsychotics in children: A cause for concern?Published: June 2009.
- Does prescribing of antipsychotics to children vary around the world?
- What are BC trends in prescribing of newer antipsychotics to children?
- What is known about the benefits and harms of newer antipsychotics in children?
- Is there evidence for use of antipsychotics in behavioural conditions?
- What are the implications of these findings for practitioners?
- References
- Letter 73. Atomoxetine for ADHD in children and adolescentsPublished: March 2009.
- Letter 72. Prescription drug costs: BC versus CanadaPublished: December 2008.
- How were the data in the Canadian Rx Atlas produced?
- Per capita cost of prescribing in BC is 28% below the national average
- How much did BC save on prescription drug costs in 2007?
- BC has the second lowest rate of increase in prescribing costs between 1998 and 2007
- Are BC’s lower prescription drug costs similar for different therapeutic categories?
- Why are prescription drug costs in BC lower than in other provinces?
- Conclusions
- References
- Letter 71. Treatment of elevated blood pressure in the very elderly Less is betterPublished: October 2008.
- Letter 70. Clinical Pearls from the most popular Cochrane reviews in 2007Published: August 2008.
- Letter 69. What is the evidence for using CNS stimulants to treat ADHD in children?Published: May 2008.
- Letter 68. Glycemic Targets in Type 2 DiabetesPublished: February 2008.
- Letter 67. Evaluating the Media as a source of Drug Therapy InformationPublished: December 2007.
- What do we know about media reports of drug therapy?
- Media Doctor Canada criteria for assessing a medical news story
- How do these criteria relate to the Vitamin D news story?
- What does recent research in Canada say about the quality of our media?
- What happens to a media outlet when its coverage is inadequate?
- What can a clinician do when confronted with a news story?
- Conclusion
- References
- Letter 66. Is newer better? New drugs for treatment of overactive bladderPublished: October 2007.
- Letter 65. Clinical implications of recent key therapeutic trialsPublished: August 2007.
- Letter 64. Your opinions of the Therapeutics Letter: The 2006 SurveyPublished: June 2007.
- Letter 63. Using Framingham for primary prevention cardiovascular risk assessmentPublished: April 2007.
- What are you calculating with a Framingham calculator?
- Over what period of time is the risk being calculated?
- What would be the estimate of CHD and CVD risk in our patient (TL 62) if we used the Framingham formulas?
- How can one use these numbers to estimate benefit of treatment?
- Has anybody done a systematic review of the accuracy and impact of risk assessment?
- What are some limitations of using a Framingham calculator?
- Conclusions
- References
- Letter 62. Mild Hypertension: An approach to using evidence in the decision making processPublished: February 2007.
- Letter 61. What is the Common Drug Review?Published: December 2006.
- Letter 60. Clinical Pearls from PrescrirePublished: September 2006.
- What is Prescrire?
- Alendronate for secondary prevention of osteoporotic fractures (Dec 1997)
- Alendronate for primary prevention of osteoporotic fractures (Jan 2000)
- Risedronate for primary and secondary prevention of osteoporotic fractures (Sep 2001)
- Alendronate 70 mg tablet (Apr 2003)
- Risedronate 35 mg tablet (Nov 2003)
- Osteoporotic fractures in men (Jun 2003)
- Topiramate for migraine prevention: best avoided (May 2006)
- Tiotropium. Just a me-too for COPD (May 2006)
- Drug Safety Update from Prescrire
- References
- Letter 59. Increasing Drug Costs: Are we getting good value?Published: July 2006.
- Letter 58. Benign Prostatic Hypertrophy: An update on drug therapyPublished: March 2006.
- Letter 57. Drugs for Overactive Bladder SymptomsPublished: December 2005.
- Letter 56. Drugs for Alzheimer’s DiseasePublished: August 2005.
- What treatment outcomes are important to patients and caregivers?
- What does AChE-I treatment achieve? Results of double blind RCTs
- What do trial results mean for patients?
- Is one AChE-I better for AD?
- New evidence about prevention of AD
- Can AChE-I therapy be discontinued?
- Memantine
- Drug costs
- Conclusions
- Key references
- References
- Letter 55. Clinical Pearls from The Cochrane LibraryPublished: March 2005.
- Corticosteroids for acute traumatic brain injury
- Fixed dose subcutaneous low molecular weight heparins (LMWH) versus adjusted dose unfractionated heparin (UFH) for venous thromboembolism
- Vaccines for preventing influenza in healthy adults
- Antiplatelet agents and anticoagulants for hypertension
- Effect of longer-term modest salt reduction on blood pressure
- References
- Letter 54. Use of Benzodiazepines in BC Is it consistent with recommendations?Published: December 2004.
- Letter 53. Rofecoxib (Vioxx®) withdrawal generates uncertainty about “ COX-2s”: Do product monographs adequately inform?Published: October 2004.
- Consider the following case
- Do COX-2 selective NSAIDs improve arthritis symptoms more than non-selective NSAIDs?
- Do COX-2 selective NSAIDs cause fewer complicated ulcers than non-selective NSAIDs?
- Do COX-2 selective NSAIDs cause more cardiovascular thrombotic events than non-selective NSAIDs?
- Case discussion
- Conclusions
- References
- Letter 52. Antidepressant Medications in Children and AdolescentsPublished: June 2004.
- Letter 51. New Drugs VIIIPublished: March 2004.
- Letter 50. Can blood pressure be lowered by a change in diet? Evidence from the DASH trialsPublished: December 2003.
- Letter 49. Statin’s benefit for secondary prevention confirmed: What is the optimal dosing strategy?Published: September 2003.
- Letter 48. Do Statins have a Role in Primary Prevention?Published: June 2003.
- Prospective Study of Pravastatin in the Elderly at Risk (PROSPER)
- Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT)
- Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm (ASCOT-LLA)
- What is the overall health impact when statins are prescribed for primary prevention?
- Conclusions
- References
- Letter 47. The Answer: Thiazides First-line for HypertensionPublished: March 2003.
- ALLHAT
- ANBP2
- Which class was best at reducing mortality and morbidity?
- Which class was best tolerated?
- Which class lowered BP the best?
- Did thiazides cause metabolic effects?
- What are the drug usage trends for hypertension in Canada?
- What are the cost implications?
- Do these results alter hypertension treatment?
- How do you increase thiazide use?
- What is the role for other classes of antihypertensive drugs?
- Conclusions
- References
- Letter 46. Menopausal Combined Hormone Therapy UpdatePublished: December 2002.
- Letter 45. Do Single Stereoisomer Drugs Provide Value?Published: September 2002.
- Letter 44. New Drugs VIIPublished: May 2002.
- Letter 43. COX-2 inhibitors update: Do journal publications tell the full story?Published: January 2002.
- Letter 42. Serious Adverse Event Analysis: Lipid-Lowering Therapy RevisitedPublished: October 2001.
- Letter 41. Asymptomatic Bacteriuria in Pregnancy: Rapid answers using the Cochrane LibraryPublished: July 2001.
- Letter 40. Direct To Consumer Advertising: Finasteride for male pattern hair lossPublished: April 2001.
- Letter 39. Selective COX-2 inhibitors: Are they safer NSAIDs?Published: February 2001.
- What is the baseline risk of peptic ulcer complications?
- What is the risk of peptic ulcer complications in patients taking NSAIDs?
- What can be done to reduce the risk of NSAID GI toxicity?
- Why might selective COX-2 inhibitors cause less peptic ulcer complications?
- How is the GI toxicity of different NSAIDs best compared?
- Do the newer more selective COX-2 inhibitors cause less serious GI toxicity?
- Are the newer selective COX-2 inhibitors safer overall?
- What important data is not provided in these RCT publications?
- What is the dose and cost of newer NSAIDs?
- Conclusions
- References
- Letter 38. Prevention and Treatment of Influenza A and BPublished: December 2000.
- Letter 37. Antiplatelet Chemoprevention of Occlusive Vascular Events and DeathPublished: October 2000.
- Letter 36. New Drugs VIPublished: August 2000.
- Letter 35. Sources of Drug Therapy InformationPublished: June 2000.
- Letter 34. New Drugs VPublished: April 2000.
- Letter 33. Treatment of Pain in the Older PatientPublished: February 2000.
- Letter 32. Management of Erectile DysfunctionPublished: November 1999.
- Letter 31. Celecoxib (Celebrex®): Is it a Breakthrough Drug?Published: September 1999.
- • Case
- • Does this drug provide a therapeutic advantage for osteoarthritis?
- • Is relative efficacy and safety information available?
- • Is relative efficacy and safety information available to the TI ?
- • How did celecoxib obtain a licence for sale in Canada?
- • Is independent verification of the TPP decision possible?
- • Why were trial reports not published?
- • Why insist on published data?
- • Future TI assessment
- • Conclusion
- Abstracts and partially reported clinical trials
- Letter 30. Levels of Evidence for Clinical Decisions: Menopausal Hormone Therapy RevisitedPublished: July 1999.
- Case
- Is there evidence available to assist us in this case?
- Is there other RCT evidence available?
- What should we advise her?
- What can be learned from this example?
- What if our patient was merely at risk for CHD (primary prevention)?
- What if our patient had a previous osteoporotic fracture instead of an MI?
- Conclusion
- References
- Letter 29. Leukotriene Antagonists: What is their role in the management of ASTHMA?Published: May 1999.
- Letter 28. Angiotensin II Receptor Blockers: Their role in hypertension and congestive heart failurePublished: March 1999.
- Letter 27. Review & Update 1998Published: December 1998.
- Letter 26. New Drugs IVPublished: October 1998.
- Letter 25. Herbal Medicines: An Evidence Based LookPublished: 1998.
- Letter 24. Lipid Lowering TherapyPublished: May 1998.
- What are the benefits of dietary therapy for secondary prevention?
- What are the benefits of drug therapy for secondary prevention?
- What are the benefits of drug therapy for primary prevention?
- Choosing a statin
- What are the major adverse effects of statins?
- Adherence to therapy
- Who will benefit most from therapy?
- By how much should you reduce LDL levels?
- Summary
- References
- Letter 23. Management of Type 2 DiabetesPublished: March 1998.
- What is the evidence that improved glucose control leads to a decrease in complications of type 2 diabetes?
- What are the new criteria for the diagnosis of diabetes mellitus?
- What are the risk factors for diabetes?
- What is the evidence for non-drug therapies?
- What drug therapies have been shown to lower blood glucose?
- Modes of action
- Conclusions
- THE THERAPEUTICS LETTER — LETTERS 1–23
- References
- Letter 22. Treatment of Acute Migraine HeadachesPublished: December 1997.
- How are migraines classified?
- What non-pharmacologic therapies are recommended?
- What oral agents are effective?
- Is there evidence that some oral agents are superior to others?
- What injectable agents are effective?
- Is there evidence that some injectable agents are superior to others?
- What intranasal therapies are effective?
- What about headache recurrence with sumatriptan?
- What about the cardiovascular effects of sumatriptan?
- Conclusions & Suggestions
- Acknowledgments
- References
- Letter 21. Effective Clinical Tobacco InterventionPublished: October 1997.
- What does smoking do to people’s health?
- Why do smokers keep smoking?
- How does tobacco addiction work?
- What do we know about smoking behaviour?
- What non-drug interventions can the clinician use to help patients quit smoking?
- What pharmacological interventions have proven effective?
- Can nicotine replacement continue long-term addiction to nicotine?
- What are the contraindications to nicotine replacement therapy?
- What other drugs can be used to treat nicotine addiction?
- What strategies should guide pharmacological therapy?
- Conclusion
- References
- Letter 20. New Drugs IIIPublished: August 1997.
- Letter 19. Medical Management of Benign Prostatic HyperplasiaPublished: June 1997.
- Letter 18. Management of Anxiety Disorders in Primary CarePublished: April 1997.
- What is the initial approach to a patient who presents with anxiety?
- What non-drug therapies are strongly recommended in managing most patients?
- How does one manage the common uncomplicated cases?
- What therapies have been proven effective in the more difficult cases?
- Practical Prescribing Tips
- Why discourage long-term benzodiazepine therapy?
- How does one manage patients who are already receiving long-term drug therapy?
- Tips for the management of Benzodiazepine withdrawal
- Conclusion
- Acknowledgments
- References
- Letter 17. New Drugs 2Published: January 1997.
- Letter 16. Review and Update 1996Published: December 1996.
- • What has changed in the past year?
- • H. pylori and Gastro-esophageal Reflux. Letter 2, 3 & 13: Nov. & Dec.’94, Mar/Apr ‘96
- • Treatment of Angina and Hypertension. Letters 6,7, 8, & 9: May-Sept. ‘95
- • What has been the response of BC physicians to the calcium channel blocker (CCB) controversy?
- • Changing concepts in the management of asthma. Letter 12: Jan–Feb. ‘96
- • Menopausal Hormone Therapy. Letter 14: May–July ‘96
- References
- Letter 15. Evidence Based Drug Therapy: What Do the Numbers Mean?Published: October 1996.
- • Why do you and your patients need to know the difference between relative risk (RR), relative risk reduction (RRR), absolute risk reduction (ARR), and number needed to treat (NTT)?
- • How can you and your patient make the most informed decision?
- • What is evidence Based Drug Therapy?
- • How does the Therapeutics Initiative compile the evidence that is presented in the Therapeutics Letter?
- • What if the evidence is inconclusive?
- REFERENCES
- Letter 14. Menopausal Hormone TherapyPublished: July 1996.
- • Definitions
- • What are the initial goals of care for the menopausal woman?
- • What are the important non-drug therapies?
- • What are the indications for hormone therapy?
- • What are the side effects that limit the use of hormone therapy?
- • What are the most convenient oral regimens?
- • What is the evidence for benefits and risks of long-term therapy?
- • What is the risk of endometrial hyperplasia and cancer?
- • What is the risk of breast cancer?
- • Does hormone therapy prevent cardiovascular disease?
- • Does hormone therapy prevent fractures associate with osteoporosis?
- • Conclusion
- Acknowledgments
- References
- Letter 13. New DrugsPublished: April 1996.
- Letter 12. Changing Concepts in the Management of AsthmaPublished: February 1996.
- • What are the goals of therapy?
- • What are the non-pharmacological therapies?
- • What is the role of the following drugs in the management of asthma?
- • Inhaled, oral, and parenteral corticosteroids
- • Cromoglycate and nedocromil inhalers and oral ketotifen
- • Long-acting β2-agonists
- • Oral theophylline
- • Inhaled ipratropium bromide
- • What is the role of the different inhaler devices and peak expiratory flow (PEF) meters?
- • Conclusion
- Acknowledgments
- References
- Letter 11. To Sleep or not to Sleep: Here are your QuestionsPublished: December 1995.
- • What are the goals of therapy in managing a patient with transient or chronic insomnia?
- • What approaches are essential in managing all patients?
- • What non-prescription drugs are useful in treating insomnia?
- • Are there clinically significant differences between available prescription hypnotics?
- • What pharmacological actions of these drugs are important to appreciate before prescribing?
- • How should I manage a new patient with insomnia?
- • How should I manage the patient who is taking a hypnotic every night?
- • What about older sedative-hypnotics?
- • Conclusions
- References
- Letter 10. Dose Titration: Minimize to MaximizePublished: October 1995.
- • What is the problem with using product monograph or CPS dosing recommendations?
- • Why are “recommended” drug doses often excessive for your patients?
- • What can we learn from the classic dose response curve?
- • How do you determine the best dose for your patients or how do you help your patient determine their best dose?
- • What about patients presently receiving chronic standard CPS doses?
- • What if you require a more rapid response to drug therapy?
- • How do I use lower doses if they are not readily available?
- • What conditions cannot be treated with a titration approach?
- • What is the optimal length of a prescription?
- References
- Letter 9. Review and UpdatePublished: September 1995.
- • What is our position on Reference Based Pricing?
- • How do we minimize bias?
- • How do we ensure relevance to patients?
- • What has changed in the last year?
- • Letter 1: H2 Blockers, Oct.’94
- • Letter 2: H. Pylori and Peptic Ulcer, Nov.‘94
- • Letter 3: Gastroesophageal Reflux, Dec.’94
- • Letter 4: NSAIDs for Osteoarthritis, Feb.’95
- • Letter 5: Anti-infective Guidelines, March‘95
- • Letter 6: Nitrates for Stable Angina, May‘95
- • Letters7,8: Treatment of Hypertension, June-Aug.‘95
- References
- Letter 8. Drugs of Choice in the Treatment of Hypertension: Part 2Published: August 1995.
- • What is the evidence that beta blockers decrease morbidity and mortality in hypertensive patients?
- • In what hypertensive patients is a beta blocker the drug of first choice?
- • In what hypertensive patients is an ACE inhibitor the drug of first choice?
- • In what hypertensive patients is a calcium antagonist the drug of first choice?
- • In what hypertensive patients are second drugs useful ?
- • Conclusion
- References
- • What is the Therapeutics Initiative?
- Letter 7. Drugs of Choice in the Treatment of Hypertension: Part 1Published: June 1995.
- • What evidence do we have about the effectiveness of antihypertensive drugs in preventing cardiovascular diseases?
- • Are there differences in blood pressure lowering efficacy?
- • Are there differences in tolerability or quality of life measures?
- • Are there differences in convenience or cost?
- • What about the metabolic consequences of thiazide therapy?
- • What is the mechanism of antihypertensive action of thiazides?
- • Conclusion
- References
- Letter 6. Medical Management of Ischemic Heart Disease: The Optimal Use of NitratesPublished: May 1995.
- • What is the drug of choice for prevention of stable angina pectoris?
- • What about the patient who is not controlled or intolerant to beta blockers?
- • How does one prevent the development of nitrate tolerance?
- • How does isosorbide dinitrate work?
- • What is the role of sustained release preparations, ointment and patches?
- • How do I switch from one preparation to another?
- • What prophylactic nitrate products are used in British Columbia?
- • How does one treat acute angina?
- References
- Letter 5. Anti-infective Guidelines for Community-Acquired InfectionsPublished: March 1995.
- Letter 4. Should we be using NSAIDS for the treatment of Osteoarthritis and “Rheumatism”Published: February 1995.
- • Is there evidence of differences in effectiveness of the different NSAIDS?
- • What is the treatment of choice for osteoarthritis?
- • Is ketorolac (Toradol) a more effective analgesic than other NSAIDS?
- • Is there evidence that NSAIDs have a disease-modifying effect?
- • What are the major risks of NSAIDs in my patients?
- • How can I minimize the risk of NSAIDs in my patients?
- • What are the least expensive NSAIDs?
- References
- Letter 3. Treatment of Gastroesophageal Reflux Disease (GERD)Published: December 1994.
- What non-pharmacologic techniques are helpful in GERD?
- What drugs decrease lower esophageal sphincter pressure and worsen GERD?
- How should one manage the patient with symptoms of heartburn?
- Are prokinetic agents useful?
- What is the treatment of choice in the patient with severe erosive esophagitis?
- What should be done in the refractory patient and in the patients who relapse?
- What are the concems about long-term omeprazole therapy?
- Conclusion
- References
- Letter 2. Definitive Treatment of Peptic Ulcer Disease by Eradication of Helicobacter Pylori (H. pylori)Published: November 1994.
- • What is H. pylori?
- • What conditions are associcded with H. pylori infestation?
- • What upper GI conditions are not associated with H. pylori infestation?
- • What treatments have been satisfactorily tested at this time?
- • What are the advantages to my patients if H. pylori is successfully eradicated?
- • What is the best treatment and how long do you treat?
- • What about safety and compliance?
- • When should you treat H. pylori infection?
- References
- Letter 1. Treatment of Non-Ulcer Dyspepsia in Adults: Common Questions about H2-blockersPublished: October 1994.
- NLM CatalogRelated NLM Catalog Entries
- Therapeutics LetterTherapeutics Letter
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