Gabapentin and Pregabalin for Pain

An interesting recent article in JAMA Internal Medicine was critical of off-label use of gabapentin (Neurontin, and generics) and pregabalin (Lyrica) for treatment of pain,1 a subject The Medical Letter has reviewed with varying degrees of skepticism for many years.2-5 Goodman and Brett point out that both drugs were originally approved as anticonvulsants, but most […]

CBD

It is everywhere, promoted for almost everything. I can hardly walk down the street without having a card pressed into my hand that extols its therapeutic virtues and offers free samples at my neighborhood store. It might be an ingredient in a smoothie or a muffin consumed by an unsuspecting buyer. Mothers feed it to […]

Epinephrine Injections for Anaphylaxis

In July of 2016, a 15-year-old girl travelling by plane from London to Nice died from an allergic reaction to sesame. She had eaten an artichoke, olive, and tapenade baguette that she had bought from a Pret A Manger store in the airport. The girl was aware of her allergy, but the sesame seeds that […]

Dietary Supplements: When Will They Ever Learn?

When we wrote about problems with dietary supplements in 2002, we concluded by saying that physicians should tell their patients that we really don’t know what’s in them. An article that recently appeared in JAMA Network Open1 tells us what’s in some of them, and it’s not good. The data in the new report comes […]

No Financial Contamination Here

The September 14, 2018 issue of The New York Times included an editorial titled “Medicine’s Financial Contamination,” prompted by the report that the (now former) chief scientific officer of Memorial Sloan Kettering Cancer Center had repeatedly failed to disclose payments from industry. The Times went on to say that even little gifts influenced doctors’ prescribing […]

Treatment of Opioid Withdrawal Symptoms

The next issue of The Medical Letter (Issue 1551, July 16, 2018) includes an article on lofexidine (Lucemyra), a new drug for management of opioid withdrawal symptoms. Lofexidine is new in the sense that it was only recently approved by the FDA, but the drug has been approved in Europe for many years for the […]

Tramadol Is an Opioid

During the recent postoperative course of a family member, I was repeatedly assured that tramadol is not an opioid and would not cause constipation. That seems to be a common misconception, possibly related to tramadol’s designation by the DEA as a Schedule IV controlled substance, a class that includes various benzodiazepines, but no other opioids. […]