The FDA has approved the marketing of Vimovo (AstraZeneca), a fixed-dose combination of the nonsteroidal anti-inflammatory drug (NSAID) naproxen and the proton pump inhibitor (PPI) esomeprazole, for symptomatic relief of osteoarthritis, rheumatoid arthritis and ankylosing spondylitis and to decrease the risk of developing gastric ulcers in patients at risk for NSAID-associated ulcers.

An FDA panel has recommended that stronger warnings about hepatotoxicity be added to the labeling for acetaminophen (www.fda.gov, search "acetaminophen hepatotoxicity").

View Table: Mechanisms of Drug Interactions

Ketorolac (kee'; toe role ak) tromethamine (Toradol), manufactured by Syntex but also marketed by Roche, is the first parenteral nonsteroidal anti-inflammatory drug (NSAID) to become available for analgesic use in the USA. Parenteral indomethacin (Indocin I.V.) has been marketed here since 1985, but only for treatment of patent ductus arteriosus in newborn infants. Other parenteral NSAIDs are available in other parts of the world, but low potency, poor aqueous solubility, and substantial tissue irritation on injection have limited their usefulness. Ketorolac has been approved by the US ...

Two new platelet glycoprotein IIb/IIIa receptor antagonists have been approved for marketing by the US Food and Drug Administration (FDA). Eptifibatide (ep ti fi' ba tyde; Integrilin - Cor, Key) is approved for use in acute coronary syndromes (unstable angina or non-Q-wave myocardial infarction) or percutaneous coronary intervention (angioplasty or atherectomy). Tirofiban (tye roe fye' ban; Aggrastat - Merck) is approved for acute coronary syndromes, but not for angioplasty without an acute coronary syndrome. Abciximab (ReoPro), a monoclonal antibody glycoprotein IIb/IIIa receptor...

Intravenous formulations of immune globulin (IVIG) have been available for more than ten years for treatment of immune deficiency (Medical Letter, 24:81, 1982). Seven preparations are now licensed in the USA, with additional indications for their use.

FluMist (MedImmune), the first live-attenuated and first intranasally administered influenza vaccine, has been approved by the FDA to prevent influenza in healthy people 5-49 years old. Given as a nasal spray, it stimulates immunity by viral replication in the upper respiratory tract. This vaccine apparently will be advertised directly to the public as a "needle-free" alternative to intramuscular influenza vaccine.

A fixed-dose combination of oxycodone 5 mg and ibuprofen 400 mg (Combunox - Forest Laboratories) is now available and is being heavily advertised for short-term treatment of moderate to severe acute pain.

Many different drugs are used for treatment of osteoarthritis pain, but none of them prevent progression of the disease. Nonpharmacologic approaches including weight management, exercise, tai chi, physical therapy, assistive devices, and total joint arthroplasty can also be used. The American College of Rheumatology (ACR) has published new guidelines for the management of osteoarthritis of the hip, hand, and knee.

Abciximab (ab sik si mab; ReoPro - Centocor), the Fab (fragment antigen binding) fragment of the chimeric human-murine monoclonal antibody 7E3 (c7E3 Fab), has been approved by the US Food and Drug Administration as an adjunct to percutaneous transluminal coronary angioplasty or atherectomy (PTCA) to prevent abrupt closure of the treated coronary vessel.