The US FDA has approved the thrombopoietin receptor agonist avatrombopag (Doptelet®, AkaRx Inc) for the prevention of bleeding events in patients with chronic liver disease and thrombocytopenia undergoing a planned medical or dental procedure.
- Thrombopoietin receptor agonist, stimulates platelet production
- Decreases serious bleed risk 2-3 fold in patients w/ severe thrombocytopenia (<50*109/L) and chronic liver disease undergoing invasive procedures for up to 7 days after procedure
- Most common adverse events: fever, abdominal pain, fatigue, edema, nausea
- Current treatment: pre-procedural platelet transfusion
- May increase risk of thromboembolism in some patients
Atorvastatin is statin-class drug commonly prescribed for the treatment of dyslipidemias and for the prevention of ischemic cardiovascular events. It works by inhibiting hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase, a key enzyme in the cholesterol biosynthetic pathway. Inhibition of HMG-CoA reductase decreases hepatic cholesterol synthesis, increases hepatic cholesterol re-uptake, and decreases serum cholesterol levels.
The US FDA has approved the cation chelator sodium zirconium cyclosilicate (ZS-9, Lokelma®) for the treatment of hyperkalemia.
Sodium Zirconium Cyclosilicate
- Oral potassium cation-exchange agent, not systemically absorbed
- Onset of action 1 hour, median 2.2 hours until normokalemic
- Not approved for life-threatening potassium elevations at this time
- Daily dosing for 1 year twice as likely as placebo to maintain normokalemia
- Most common adverse effects: GI distress, hypokalemia, UTI, edema
- Adverse effects less frequent than patiromer (alternative chelating agent for hyperkalemia)
The US FDA has approved the alpha-adrenergic agonist lofexidine HCl (Lucemyra®) for the treatment of opioid withdrawal symptoms.
- First non-opioid approved for treating opioid withdrawal symptoms
- Approved for up to 14 days after discontinuation of opioids
- Alpha-2 adrenergic agonist, suppresses sympathetic outflow
- Originally developed in 1980s for management of hypertension
- Most common side effects: hypotension, bradycardia, sedation and dizziness
- Alternative treatments for opioid withdrawal: gradual opioid dose taper, switch to less addictive opioids (e.g., methadone, buprenorphine), use opioid receptor antagonists (naltrexone)
Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor used in the treatment of hypertension and congestive heart failure. It acts by inhibiting the conversion of angiotensin I to angiotensin II, lowering serum levels of the vasopressor hormone angiotenin II. Decreased angiotensin II receptor stimulation also decreases adrenal secretion of aldosterone.
The US FDA has approved the first antibody therapy, erenumab (Aimovig®) for the prevention of migraine headaches.
- Human monoclonal antibody
- Calcitonin-gene related peptide (CGRP) antagonist
- 1-2.5 fewer migraines/month
- Once-monthly self-injectable
- $6900/year before insurance and discounts
- Adverse effects: Injection site reactions and constipation