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Old Drugs That Are Still Good Drugs in 2018

Douglas S. Paauw, MD; Joanna M. Pangilinan, PharmD; Laurie Scudder, DNP, NP | January 2, 2018 | Contributor Information

Although attention is often paid to the newest and most expensive blockbuster drugs, let's not forget older drugs that have stood the test of time for prevention and treatment of a variety of conditions. Here are 21 that should enter the new year with you and your prescription pad.

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Old Drugs That Are Still Good Drugs in 2018

Douglas S. Paauw, MD; Joanna M. Pangilinan, PharmD; Laurie Scudder, DNP, NP | January 2, 2018 | Contributor Information

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Old Drugs That Are Still Good Drugs in 2018

Douglas S. Paauw, MD; Joanna M. Pangilinan, PharmD; Laurie Scudder, DNP, NP | January 2, 2018 | Contributor Information

Isoniazid

Isoniazid was first synthesized in 1912, and activity against tuberculosis was identified in 1945. More than 100 years later, and despite growing drug resistance, isoniazid is still a standard component of multidrug treatment regimens for both pulmonary and extrapulmonary disease, although drug susceptibility testing should be performed for previously treated patients.[1]

For more, refer to our Drugs & Diseases discussion of tuberculosis therapy.

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Old Drugs That Are Still Good Drugs in 2018

Douglas S. Paauw, MD; Joanna M. Pangilinan, PharmD; Laurie Scudder, DNP, NP | January 2, 2018 | Contributor Information

Penicillin

Penicillin was discovered in 1928, when Alexander Fleming observed that the mold Penicillium notatum destroyed colonies of Staphylococcus aureus. Use as an antibiotic began in the 1940s. Today, penicillin still has activity against many microbes and is recommended as first-line treatment for group A beta-hemolytic streptococcal (GABHS) pharyngitis.[2] Pneumococcal resistance to penicillin varies substantially by region,[3] but to date, no clinical isolate of penicillin-resistant GABHS penicillin has been reported.[4] In fact, the much larger concern is the reported overdiagnosis of penicillin allergy, particularly in children.[5,6]

For more, refer to our special report on penicillin allergy.

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Old Drugs That Are Still Good Drugs in 2018

Douglas S. Paauw, MD; Joanna M. Pangilinan, PharmD; Laurie Scudder, DNP, NP | January 2, 2018 | Contributor Information

Sulfa

In 1932, a German pathologist found that prontosil, a chemical derivative from azo dyes, had antibacterial activity, which was later attributed to its metabolism to sulfanilamide.[7] In the hands of the Nazi regime, experiments using sulfanilamide were carried out at the all-female Ravensbrück concentration camp[8]—an ordeal recently chronicled in the novel Lilac Girls.

Sulfonamides are effective against many gram-positive and gram-negative bacteria and protozoa. Although sulfas remain a backbone of antimicrobial therapy, adverse effects, drug allergy, introduction of newer antibiotics, and resistance have reduced their utility.[9] Resistance to one sulfonamide means resistance to all.[10]

Trimethoprim/sulfamethoxazole has had a resurgence, because it is a first-line treatment for the ever-growing problem of community-acquired methicillin-resistant S aureus (MRSA).[11] It must be used carefully, especially in elderly persons, because of the risk for hyperkalemia.

For more, refer to our case challenge on hyperkalemia.

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Old Drugs That Are Still Good Drugs in 2018

Douglas S. Paauw, MD; Joanna M. Pangilinan, PharmD; Laurie Scudder, DNP, NP | January 2, 2018 | Contributor Information

The Tetracyclines

Tetracycline was patented in 1955, and within 3 years, it was the most prescribed broad-spectrum antibiotic in the United States.[12] Although tetracyclines continue to be used for the treatment of chlamydia, spirochetal infections, anthrax, plague, tularemia, and other infections,[13] widespread use, particularly in veterinary medicine, has led to rising rates of resistance.[14] In particular, some pneumococcal strains and many GABHS, gram-negative bacillary uropathogens, and penicillinase-producing gonococci are resistant to tetracycline.[13] However, most community-acquired MRSA isolates are sensitive to both doxycycline and minocycline,[15] and these two drugs are also used for the treatment of acne. Recent research has focused on the anti-inflammatory properties of tetracyclines, particularly minocycline, and the potential for neuroprotection against Alzheimer disease,[16] stroke,[17] and neuromuscular disorders.[18]

For more, refer to our Drugs & Diseases discussion of tetracycline.

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Old Drugs That Are Still Good Drugs in 2018

Douglas S. Paauw, MD; Joanna M. Pangilinan, PharmD; Laurie Scudder, DNP, NP | January 2, 2018 | Contributor Information

Image from Dreamstime

Old Drugs That Are Still Good Drugs in 2018

Douglas S. Paauw, MD; Joanna M. Pangilinan, PharmD; Laurie Scudder, DNP, NP | January 2, 2018 | Contributor Information

Aspirin

Derived from willow bark, aspirin has been marketed since 1899 for pain relief. Although it has been largely replaced by other products for simple pain control, it is still a reasonable option in some cases. Aspirin also has a role in preventing pain. A recent systematic review concluded that regular use may reduce the frequency of migraine.[19]

Today, it is used primarily for its antithrombotic properties in cardiovascular disease (CVD), including initial myocardial infarction (MI) management (chewable aspirin), and prevention of MI and stroke. Guidelines have varied and sometimes conflicted; yet in 2016, the US Preventive Services Task Force (USPSTF) recommended aspirin for primary prevention of CVD in some populations of adults.[20]

A growing body of evidence demonstrates a reduction in colorectal cancer rates in individuals who use aspirin.[21-23] In fact, that same 2016 USPSTF guideline recommended aspirin for primary prevention of both CVD and colorectal cancer in some adults aged 50 years or older.[20] However, recent data suggest that aspirin use among adults for whom it is indicated is suboptimal.[24]

For more, refer to our Drugs & Diseases discussion of aspirin.

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Old Drugs That Are Still Good Drugs in 2018

Douglas S. Paauw, MD; Joanna M. Pangilinan, PharmD; Laurie Scudder, DNP, NP | January 2, 2018 | Contributor Information

Digoxin

Digitalis, obtained from the foxglove plant (Digitalis purpurea), has vexed physicians for hundreds of years owing to its narrow therapeutic window.[25] "Modern" digitalis use may be attributed to the British physician and botanist William Withering, whose famous record of digitalis use for "dropsy" was published in 1785.[26] Notorious even in fictional literature, mention of foxglove/digitalis toxicity can be found in stories by Agatha Christie and George Eliot.[25]

Every year in the United States, millions of digoxin prescriptions are written; unfortunately, digoxin toxicity is responsible for an estimated 5000 emergency department visits annually.[27] Emerging data question its safety for atrial fibrillation[28,29] and heart failure.[30] The efficacy of digoxin for atrial fibrillation is minimal, because it does not significantly reduce the exertional heart rate. Digoxin is not recommended in the 2017 update of the guidelines for heart failure management issued by the American Heart Association, the American College of Cardiology, and the Heart Failure Society of America.[31]

For more, refer to our Drugs & Diseases discussion of digoxin.

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Old Drugs That Are Still Good Drugs in 2018

Douglas S. Paauw, MD; Joanna M. Pangilinan, PharmD; Laurie Scudder, DNP, NP | January 2, 2018 | Contributor Information

Nitroglycerin

Nitroglycerin was first used in 1867 to treat angina, and to this day is the primary pharmacologic agent for both acute angina and angina prophylaxis.[32] In combination with two other commonly used older drugs, morphine and aspirin, nitroglycerin is a critical component of the initial management of acute coronary syndrome.[33] It also continues to have a role for the induction of surgical hypotension.

Researchers continue to find new uses for nitroglycerin, particularly in topical form. One of the more interesting applications is for the treatment of lateral epicondylitis.[34,35] Other recent studies of transdermal nitroglycerin preparations have found that it may provide pain relief for patients with diabetic neuropathy.[36] Because of its vasoactive potential, nitroglycerin has also been studied as a potential adjunct to anticancer agents to enhance penetration into tumors.[37]

For more, refer to our Drugs & Diseases discussion of sublingual nitroglycerin.

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Old Drugs That Are Still Good Drugs in 2018

Douglas S. Paauw, MD; Joanna M. Pangilinan, PharmD; Laurie Scudder, DNP, NP | January 2, 2018 | Contributor Information

Spironolactone

Spironolactone, a weak diuretic and aldosterone antagonist, was introduced in 1959. A guideline update released in 2017 continued to recommend its use in the treatment of patients with heart failure with preserved ejection fraction.[31] It also has an important role in the management of hypertension refractory to initial therapies. Primary aldosteronism, the most common form of secondary hypertension, affects an estimated 5%-10% of patients with refractory hypertension and is a condition for which the use of spironolactone is extremely effective.[38] More recent research suggests that aldosteronism may be present in patients with less severe hypertension and may even be found in normotensive individuals.[39]

Eplerenone, a newer aldosterone antagonist, has a more favorable adverse event profile—most notably, a lower incidence of gynecomastia[40]—and may eventually supersede spironolactone.[41] A clinical trial comparing spironolactone and eplerenone in patients with glucose intolerance or diabetes is expected to report results in spring 2018. However, spironolactone is inexpensive, so it is likely that it will continue to have an important role.

For more discussion about the 2017 guideline update, Dr Ileana Piña provides a video snapshot.

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Old Drugs That Are Still Good Drugs in 2018

Douglas S. Paauw, MD; Joanna M. Pangilinan, PharmD; Laurie Scudder, DNP, NP | January 2, 2018 | Contributor Information

Non-loop Diuretics

Early diuretics were herbal derivatives that had been in use at least since the 16th century, when they were key agents for treating edema. The first diuretic compounds, organomercurials, were replaced by carbonic anhydrase inhibitors in the mid-1940s. By 1960, hydrochlorothiazide had been approved; around that same time, the American Heart Association and the National Institutes of Health reported declining death rates, which they partly attributed to the new thiazide antihypertensives.[42] The value of thiazide diuretics in treating hypertension has been steady. Thiazides remain a backbone of initial antihypertensive therapy guidelines and are also recommended as second- and third-line alternatives in combination with other agents.[43]

Another older diuretic, chlorthalidone, has the strongest outcomes data[44] and is the preferred first-line agent recommended in the 2017 updated American College of Cardiology/American Heart Association guideline for the treatment of hypertension when no other comorbidities exist.[45]

For more, refer to our discussion of the new hypertension guidelines.

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Old Drugs That Are Still Good Drugs in 2018

Douglas S. Paauw, MD; Joanna M. Pangilinan, PharmD; Laurie Scudder, DNP, NP | January 2, 2018 | Contributor Information

Warfarin

Warfarin's effects were first noted in the 1920s, when cattle hemorrhaged after eating spoiled sweet clover. That finding led to its widespread use as a rodenticide. But after a Navy recruit ingested a large amount in a suicide attempt and lived, it was recognized that the drug could be used in humans.[46] In 1954, it was approved for prevention of thrombosis and thromboembolism and is still among the most widely prescribed oral anticoagulants in the United States.[47] However, widespread uptake of the newer direct oral anticoagulants (DOACs), such as direct thrombin inhibitors (eg, dabigatran) and factor Xa inhibitors (eg, apixaban, rivaroxaban, edoxaban), which do not require monitoring of the international normalized ratio and are associated with fewer drug/drug interactions, has led to a corresponding decrease in use of warfarin.[48] In current practice, on the basis of slightly increased efficacy and actual lower bleeding risk, factor Xa inhibitors are becoming the preferred option for anticoagulation for patients with atrial fibrillation. Dabigatran is the only DOAC for which a reversal agent, idarucizumab (Praxbind®), is available; idarucizumab was approved by the US Food and Drug Administration (FDA) in 2015.[49] The lack of reversal agents for other DOACs, a theoretical concern when they first entered the market, has not been shown to be a significant issue.

However, warfarin's longer duration of action and lower cost, and the ability to monitor adherence in patients at high risk for nonadherence, all combine to create a continuing need for warfarin.[50]

For more, refer to our Drugs & Diseases discussion of warfarin.

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Old Drugs That Are Still Good Drugs in 2018

Douglas S. Paauw, MD; Joanna M. Pangilinan, PharmD; Laurie Scudder, DNP, NP | January 2, 2018 | Contributor Information

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Old Drugs That Are Still Good Drugs in 2018

Douglas S. Paauw, MD; Joanna M. Pangilinan, PharmD; Laurie Scudder, DNP, NP | January 2, 2018 | Contributor Information

Corticosteroids

In the 1930s, six hormones were isolated from adrenal glands, one of which was cortisol. Almost 20 years later, cortisone, a synthetic version, was first used to treat a patient with rheumatoid arthritis.[51] Used in the treatment of conditions ranging from atopic dermatitis to inflammatory bowel disease and chronic obstructive pulmonary disease, corticosteroids are critically important for many acute and chronic illnesses. Numerous drug-delivery systems, including topical application, oral administration, intravenous preparations, products for inhalation, cochlear implants, and intravitreal inserts, allow targeted delivery, lower effective doses, and long-term use. One new kid on the block is an extended-release, intra-articular injection for osteoarthritis knee pain, which was approved by the FDA in October 2017.

The benefits of short-term use of steroids and the adverse effects associated with chronic use are both well-documented. However, clinical data on the adverse effects of short-term use are sparse. A recent study found that as many as 20% of US adults covered by commercial health insurance plans were prescribed at least one course of oral steroids over a 3-year period, with a substantial number of these patients experiencing an adverse event.[52] The advice to use the lowest dose for the shortest period continues to be wise.

To read the full text of the recent study examining patterns and harms of short-term use, click here.

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Old Drugs That Are Still Good Drugs in 2018

Douglas S. Paauw, MD; Joanna M. Pangilinan, PharmD; Laurie Scudder, DNP, NP | January 2, 2018 | Contributor Information

Insulin

Insulin was identified in 1869 and first used in humans in the 1920s, turning a previously deadly condition into a manageable chronic disease. Many new formulations have been developed, including fast-acting (eg, aspart, lispro, glulisine), ultra–fast-acting (Fiasp®), and long-acting (eg, detemir, glargine, degludec). Combinations of long-acting insulins with glucagon-like peptide 1 receptor agonists have been approved. More recently, an inhaled product (Afrezza®) has come on the market. Insulin analogues have primarily replaced older human insulins, although cost has increasingly become a concern with these newer agents.

For more, refer to our Drugs & Diseases discussion of insulin.

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Old Drugs That Are Still Good Drugs in 2018

Douglas S. Paauw, MD; Joanna M. Pangilinan, PharmD; Laurie Scudder, DNP, NP | January 2, 2018 | Contributor Information

Metformin

First synthesized in the 1920s, metformin was neglected for the next two decades as research focused on insulin and other antidiabetes drugs. The 1940s saw resurging interest in metformin's ability to reduce blood glucose, and in 1957 it was first tested for diabetes. It wasn't introduced to the United States, however, until 1995. In the absence of contraindications, metformin is currently recommended as the first-line oral therapy for type 2 diabetes.[53] In 2016, the FDA relaxed the guidelines on metformin use in patients with chronic kidney disease, allowing patients with estimated glomerular filtration rates of 30 mL/min/1.73 m2 and above to remain on metformin.[54]

It is formulated as a single agent and in combination with various other antidiabetes drugs. In addition, compelling evidence now supports its use to prevent progression from prediabetes to diabetes,[55] particularly in women with a history of gestational diabetes.[56] Metformin is now recommended for the treatment of obesity in patients with type 1 diabetes.[57,58] and as an important agent in treating polycystic ovary syndrome and its complications.[59]

It continues to be widely studied, and evidence is emerging of wide-ranging benefits, most notably a statistically significant decrease in the risk for colon cancer.[60,61] Although there is some evidence of reduction in both the incidence of and death from other types of cancer, those data are less convincing.[62,63]

For more, refer to our Drugs & Diseases discussion of metformin.

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Old Drugs That Are Still Good Drugs in 2018

Douglas S. Paauw, MD; Joanna M. Pangilinan, PharmD; Laurie Scudder, DNP, NP | January 2, 2018 | Contributor Information

Propylthiouracil

Renowned biomedical researcher Dr Edwin Astwood (1909-1976) discovered propylthiouracil after he noted that certain chemical substances being tested for non–thyroid-related reasons caused goiter in rats. With early use of radioactive iodine, Astwood and his lab subsequently identified methimazole.[64]

Approved in 1947,[65] propylthiouracil remains an important agent for Graves disease with hyperthyroidism.[66] In 2010, a black-box warning was added to its labeling, warning of the risk for severe liver injury and acute liver failure associated with use.[67]

For more, refer to our Drugs & Diseases discussion of propylthiouracil.

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Old Drugs That Are Still Good Drugs in 2018

Douglas S. Paauw, MD; Joanna M. Pangilinan, PharmD; Laurie Scudder, DNP, NP | January 2, 2018 | Contributor Information

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Old Drugs That Are Still Good Drugs in 2018

Douglas S. Paauw, MD; Joanna M. Pangilinan, PharmD; Laurie Scudder, DNP, NP | January 2, 2018 | Contributor Information

Acetaminophen

In 1884, a pharmacy in Strasbourg erroneously dispensed acetanilide for a patient with worm infestation. The infestation did not improve, but surprisingly, the patient's fever did. This error ultimately led to the discovery of acetaminophen (APAP).[68]

Every week, more than 50 million Americans use a product containing APAP, which is found in over 600 over-the-counter and prescription products.[69] However, intentional and unintentional overdoses result in over 75,000 emergency department visits[70] and about 30,000 hospitalizations for APAP toxicity annually.[71] Almost one- fifth (15%) of patients with unintentional APAP overdose will experience liver injury.[71]

The FDA has recommended that prescription combination products contain no more than 325 mg APAP per dosage form and asked providers not to prescribe prescription combination products containing over 325 mg of APAP per dosage form. While the FDA has not changed its recommendation of a maximum adult dose of 4000 mg per day,[72,73] some manufacturers[74] have changed dosing guidelines for certain APAP products to a daily maximum of 3000 mg, unless directed otherwise.

For more, refer to our Drugs & Diseases discussion of acetaminophen.

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Old Drugs That Are Still Good Drugs in 2018

Douglas S. Paauw, MD; Joanna M. Pangilinan, PharmD; Laurie Scudder, DNP, NP | January 2, 2018 | Contributor Information

Morphine

Derived from opium, morphine was first sold in 1827. Since then, morphine has been produced in a range of formulations from oral to intravenous, including patient-controlled analgesia, and is widely used for both acute and chronic pain control. Synthetic opioids, primarily fentanyl and its analogues (which were initially marketed as abuse-deterrent options) are widely available. Unfortunately, opioid abuse has become the most rapidly escalating public health crisis of the day, with over 35,000 deaths in the United States in 2016 alone,[75] and has been declared a public health emergency. Although overuse and abuse are indeed enormous concerns, opioids in general will continue to be a necessary tool for the management of pain.[76,77]

For more on the use of opioids, please refer to a recent commentary by noted pain management expert Dr Charles Argoff.

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Old Drugs That Are Still Good Drugs in 2018

Douglas S. Paauw, MD; Joanna M. Pangilinan, PharmD; Laurie Scudder, DNP, NP | January 2, 2018 | Contributor Information

Naloxone

A discussion of pain management must by necessity include the opioid antagonist naloxone, which, since its approval in 1971, has helped save countless lives. From 1996 through June 2014, laypersons reversed over 26,000 opioid overdoses in the United States using naloxone.[78]

Use of naloxone for opioid overdose has been hampered by cost and access.[79] Professional societies have argued for its availability to first responders and caregivers. Recognizing the importance of naloxone, all 50 states and the District of Columbia have modified their laws to increase naloxone access for laypersons[80]; some states have standing order prescriptions for naloxone. In addition, most states and the District of Columbia have passed an overdose Good Samaritan law providing some protection for individuals who report an overdose in good faith.[80]

Naloxone is available as an injection, autoinjector, and nasal spray.

For more, refer to our Drugs & Diseases discussion of naloxone.

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Old Drugs That Are Still Good Drugs in 2018

Douglas S. Paauw, MD; Joanna M. Pangilinan, PharmD; Laurie Scudder, DNP, NP | January 2, 2018 | Contributor Information

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Old Drugs That Are Still Good Drugs in 2018

Douglas S. Paauw, MD; Joanna M. Pangilinan, PharmD; Laurie Scudder, DNP, NP | January 2, 2018 | Contributor Information

Allopurinol

The ability of allopurinol to inhibit xanthine oxidase was discovered in the 1950s during the "purine revolution."[81] Its use for hyperuricemia began shortly thereafter, and it was approved by the FDA in 1966. Decades later, allopurinol has been proven to be safe and effective and is recommended as a urate-lowering agent for preventing recurrent gout.[82] Its potential cardioprotective effect is garnering attention, with research finding that allopurinol may reduce cardiovascular risk and slow the rate of progression of kidney disease.[83]

For more, refer to our Drugs & Diseases discussion of allopurinol.

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Old Drugs That Are Still Good Drugs in 2018

Douglas S. Paauw, MD; Joanna M. Pangilinan, PharmD; Laurie Scudder, DNP, NP | January 2, 2018 | Contributor Information

Colchicine

Use of colchicine, a compound in the autumn crocus (Colchicum autumnale), dates as far back as 1500 BC, and its first recorded use for the treatment of gout was in the first century AD. Numerous studies utilizing large cohorts of patients with gout who had been taking the drug for years have suggested possible novel uses of the agent to treat a range of immunologic, cardiac, and dermatologic conditions, along with several cancers.[84]

In recent years, colchicine has been recognized for its anti-inflammatory potential, with short-term use rapidly and significantly reducing interleukin (IL)-1 beta, IL-18, and downstream IL-6 levels.[85] Colchicine has several cardiac benefits and may be used in treatment for recurrent pericarditis and for prevention of postpericardiotomy syndrome.[86] It has a possible benefit in patients with stable coronary disease,[87] and its use was associated with plaque stabilization when added to optimal medical therapy in post-acute coronary syndrome patients—an outcome that researchers attribute to its anti-inflammatory effect.[88] A 2016 Cochrane reviewed concluded that more study was needed, noting that there continues to be uncertainty about its use for CVD prevention, especially in less high-risk populations.[89]

A 2017 guideline update continues to recommend colchicine as first-line treatment of acute gout and cites evidence suggesting a role for colchicine in prevention of acute gout flares in patients initiating urate-lowering therapy.[82] Colchicine is also a mainstay in the treatment of familial Mediterranean fever.[90]

For more, refer to our Drugs & Diseases discussion of colchicine.

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Old Drugs That Are Still Good Drugs in 2018

Douglas S. Paauw, MD; Joanna M. Pangilinan, PharmD; Laurie Scudder, DNP, NP | January 2, 2018 | Contributor Information

Image courtesy of Wikimedia Commons

Old Drugs That Are Still Good Drugs in 2018

Douglas S. Paauw, MD; Joanna M. Pangilinan, PharmD; Laurie Scudder, DNP, NP | January 2, 2018 | Contributor Information

Ergotamine

Invasion of rye, wheat, or other cereal grasses by the parasitic fungus Claviceps purpurea turns grain into sclerotia containing ergot alkaloids. Ingestion of ergot alkaloids is associated with diverse effects, such as vasoconstriction, uterine contractions, and hallucinations.[91] Epidemics of ergot poisoning (ergotism, also known as "St Anthony's Fire") have caused thousands of deaths,[91] and some suggest that ergot poisoning was responsible for the bizarre behaviors leading to the Salem witch trials.[92]

Although ergot derivatives continue to have many uses, prescribers may be most familiar with their role in the management of migraine. Before triptans became available, ergotamine and dihydroergotamine were the only specific antimigraine agents.[93] Other unapproved ergotamine-containing agents for migraine were removed from the market in 2007 by the FDA.[94] With careful use, ergotamine and dihydroergotamine continue to be treatment options for acute migraine.[95] However, with the relative safety and effectiveness of triptans, they have been relegated to a lesser role for migraine treatment.[96]

For more, refer to our Drugs & Diseases discussion of ergot derivatives and migraine.

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Old Drugs That Are Still Good Drugs in 2018

Douglas S. Paauw, MD; Joanna M. Pangilinan, PharmD; Laurie Scudder, DNP, NP | January 2, 2018 | Contributor Information

Lithium

Lithium has probably been used for medicinal purposes for thousands of years. In the early second century AD, Soranus of Ephesus, a Greek physician in ancient Rome, referred to use of alkaline mineral waters for the treatment of mania.[97] Used as a pharmacologic agent since the 1870s, lithium was approved by the FDA in 1970.[98]

Lithium continues to be the most effective agent for preventing relapse and hospital admission in bipolar I disorder.[99] But toxicity may occur, and with lithium's narrow therapeutic window, monitoring of serum levels is necessary. It also has a role as an add-on treatment for refractory major depression.[100]

Recent research has found that naturally occurring lithium in drinking water may reduce risk for dementia and suicide. Lithium may even reduce risk for cancer.

For more, refer to our Drugs & Diseases discussion of lithium.

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11 Drugs You Should Seriously Consider Deprescribing

You might consider 'giving the axe' to these 11 drug classes in specific circumstances, to increase safety and reduce a patient's pill burden.Medscape Features Slideshows, September 2017
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