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. […]

Opioids Again and Again

The CDC reported today that the opioid crisis is only getting worse: more ED visits, more deaths. More than from car accidents, more than from guns. Unbelievable, but we believe it and we are doing what we can to help. In the June 5th, 2017 issue of The Medical Letter, we published an article on […]

Alternatives to Hormonal Contraceptives

The results of a large Danish prospective cohort study (1.8 million women followed for an average of 10.9 years) published recently in The New England Journal of Medicine indicate that even low-estrogen oral contraceptives and progestin-only intrauterine devices are associated with an increased risk of breast cancer.  The risk was 20% higher in current or […]

What a Sham: The Power of Placebo

The November 2, 2017 issue of The Lancet included an online first article (R. Al-Lamee et al) describing a sham-controlled trial of percutaneous coronary intervention (PCI) in the treatment of stable angina pectoris. Each year more than 500,000 PCI procedures are done for stable angina worldwide and unblinded randomized trials have shown significant relief of […]

ALL

I don’t remember her name anymore. She was 8 years old: blonde, pretty, smiling politely. I remember her parents, older than most, looking concerned. She looked too healthy to be the source of their concern, but as I moved close to her, I could see the petechiae on her cheeks. In three weeks, she was […]

One Drug Interaction

The unveiling of Drug Interactions from The Medical Letter® reminded me of the profound effects of a single drug interaction that occurred in the emergency room of New York Hospital in 1984. Libby Zion was an 18-year-old college student who came to the hospital seeking treatment for a flu-like illness. She had been taking the […]