Dual antiplatelet therapy for minor ischemic stroke and transient ischemic attack.

Traditional preventive management of patients suffering from a minor ischemic stroke and/or transient ischemic attack indicated dual antiplatelet agents for 90 days. Newer clinical trial data suggest that therapeutic effectiveness is reached much sooner than previous guideline recommendations. Continued use of dual antiplatelet therapy beyond newly studied durations of efficacy has shown an increased risk in hemorrhagic complications with little to no additional preventive benefit.

Flibanserin for hypoactive sexual desire disorder in premenopausal women.

Flibanserin is a mixed 5-HT1A agonist and 5-HT2A antagonist for treatment of premenopausal women with hypoactive sexual desire disorder. It is the first FDA-approved treatment for this disorder and can improve the number of satisfying sexual events. The drug has been associated with hypotension and syncope.

Can the anticoagulant effects of dabigatran be reversed?

Idarucizumab is a humanized monoclonal antibody fragment for reversal of the anticoagulant effects of dabigatran. This drug can be used for patients who need emergency surgery or invasive procedures, as well as those with life-threatening or uncontrolled bleeding.

What are the latest recommendations for pneumococcal vaccines?

The Advisory Committee on Immunization Practices recently updated its guidelines on pneumococcal pneumonia vaccines for older adults. The new guidelines recommend that patients age 65 years and older receive the PCV13 vaccine in a series along with the PPSV23 vaccine. This article summarizes these changes along with a review of when to vaccinate other key adult populations.

Is combination therapy appropriate for hypothyroidism?

Levothyroxine is the first-line drug for treating hypothyroidism. This article reviews the literature on combination therapy using levothyroxine and liothyronine, and found that only one study produced beneficial outcomes; other studies reported increased adverse reactions among participants. Levothyroxine should remain the drug of choice for hypothyroidism.

Are antidepressants safe in the first trimester of pregnancy?

Antidepressants have been linked to cardiac malformations when used early in pregnancy, particularly the first trimester. However, recent analyses suggest that the overall risk of malformations is very low. When determining appropriate therapy for pregnant women or women who plan to become pregnant, providers should consider the growing body of evidence compared with the potential harm caused if maternal medical conditions are not treated.

Which oral valproic acid formulation is best for my patient?

The various oral formulations of valproic acid vary in dosing frequency, form, indication, and cost. This article describes how to determine which formulation to prescribe based on factors including the patient's diagnosis and financial situation.

Canagliflozin: a new option for managing diabetes.

Canagliflozin is a sodium glucose cotransporter 2 inhibitor for patients with type 2 diabetes and can be given as monotherapy or in combination with other agents, including insulin. Taken orally once daily, canagliflozin can reduce weight and BP, but has been associated with genital mycotic infections.

Exenatide extended-release: a once-weekly option for patients with type 2 diabetes.

Exenatide extended-release is a new long-acting glucagon-like peptide-1 agonist that may be an attractive option for patients desiring to lose weight, who are prone to hypoglycemic episodes, and who have not achieved desired glycemic control with current therapy.

How can NSAIDs harm cardiovascular and renal function?

Consider the potential cardiovascular and renal effects of nonsteroidal anti-inflammatory drugs when evaluating a patient for short- or long-term use of these drugs. Monitoring and extensive counseling is warranted with this particular class of medications.