American Family Physician

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STEPS

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STEPS: Suvorexant (Belsomra) for Insomnia - American Family Physician

Jun 15, 2016 - Suvorexant effectively increases total sleep time and decreases time to sleep onset. Because of its risk of abuse, significant incidence of next-day impairment, and high cost, it should be reserved for use in patients for whom other insomnia therapies, such as cognitive behavior therapy...

American Family Physician : STEPS

http://www.aafp.org/afp/2016/0615/p1016.html

STEPS: Flibanserin (Addyi) for Hypoactive Sexual Desire Disorder in Premenopausal Women...

May 15, 2016 - Although flibanserin results in a modest improvement in the number of satisfying sexual events (approximately one more per month vs. placebo), it does not improve other measures, is considerably expensive, and has significant adverse effects.

American Family Physician : STEPS

http://www.aafp.org/afp/2016/0515/p826.html

STEPS: Ivabradine (Corlanor) for Heart Failure - American Family Physician

Apr 15, 2016 - In patients with stable systolic heart failure already on maximal medication therapy, adding ivabradine may reduce the number of hospitalizations related to heart failure (NNT for two years = 20), but it does not reduce cardiovascular mortality. In addition, many patients will not ...

American Family Physician : STEPS

http://www.aafp.org/afp/2016/0415/p682.html

STEPS: Conjugated Estrogens/Bazedoxifene (Duavee) for Menopausal Symptoms - American ...

Feb 15, 2016 - Conjugated estrogens/bazedoxifene is effective for the treatment of menopausal symptoms and may be better tolerated than conjugated estrogens/medroxyprogesterone. It will maintain bone mineral density in the lumbar spine and hip, but its effect on fractures is not known. Cardiovascular ...

American Family Physician : STEPS

http://www.aafp.org/afp/2016/0215/p307.html

STEPS: Naltrexone/Bupropion (Contrave) for Weight Loss - American Family Physician

Apr 15, 2015 - Naltrexone/bupropion produces clinically significant weight loss when combined with a diet and exercise program. It decreases body weight in patients with diabetes, but its effect on diabetic outcomes is not known. A significant proportion of patients will experience adverse effects.

American Family Physician : STEPS

http://www.aafp.org/afp/2015/0415/p554.html

STEPS: Timothy Grass Pollen Allergen Extract (Grastek) for Allergic Rhinitis - American...

Dec 15, 2015 - Timothy grass pollen allergen extract produces small improvements in allergic rhinitis symptoms and the use of allergy relief medications, with a high rate of adverse effects. It may, however, be an option for patients who desire an alternative to standard allergy symptom relief but who...

American Family Physician : STEPS

http://www.aafp.org/afp/2015/1215/p1096.html

STEPS: Levomilnacipran (Fetzima) for Major Depressive Disorder - American Family Physician

Oct 15, 2015 - Levomilnacipran should not be used in patients with mild to moderate depression until studies have proven its effectiveness. It is somewhat effective in patients with moderate to severe depression. The short-term adverse effect profile of levomilnacipran is similar to that of other SNRIs.

American Family Physician : STEPS

http://www.aafp.org/afp/2015/1015/p727.html

STEPS: Apixaban (Eliquis) for Stroke Prevention in Atrial Fibrillation - American ...

Apr 15, 2014 - Apixaban is at least as effective as aspirin or warfarin for preventing strokes in high-risk patients with nonvalvular atrial fibrillation, especially those who cannot or will not take warfarin. It is slightly less likely to cause major bleeding and may have better compliance because it...

American Family Physician : STEPS

http://www.aafp.org/afp/2014/0415/p672.html

STEPS: Vorapaxar (Zontivity) for the Prevention of Thrombotic Cardiovascular Events - ...

Aug 15, 2015 - Vorapaxar should be limited to select patients with a history of MI or peripheral arterial disease who desire additional treatment for the prevention of MI.

American Family Physician : STEPS

http://www.aafp.org/afp/2015/0815/p304.html

STEPS: Vortioxetine (Brintellix) for the Treatment of Depression - American Family ...

Mar 1, 2015 - Current evidence does not support the routine use of vortioxetine in the treatment of depression. Family physicians most often encounter patients with mild to moderate depression, and vortioxetine has not been studied in this population. There is no clear benefit of using vortioxetine ...

American Family Physician : STEPS

http://www.aafp.org/afp/2015/0301/p325.html

STEPS: Dapagliflozin (Farxiga) for Type 2 Diabetes Mellitus - American Family Physician

Jun 15, 2015 - Dapagliflozin will lower A1C levels by an average of 0.7 percentage points when used alone or by an average of 0.5 percentage points when added to metformin therapy. Its effect on diabetes-associated morbidity and mortality has not been studied, and although it is well tolerated, there ...

American Family Physician : STEPS

http://www.aafp.org/afp/2015/0615/p828.html

STEPS: Phentermine/Topiramate (Qsymia) for Chronic Weight Management - American Family ...

Oct 15, 2014 - Phentermine/topiramate has been shown to be a good option for sustained weight loss in patients who are unable to lose weight with diet and exercise alone. It should not be given to patients with a history of significant heart disease, and women of childbearing age should use ...

American Family Physician : STEPS

http://www.aafp.org/afp/2014/1015/p576.html

STEPS: Lorcaserin (Belviq) for Weight Loss - American Family Physician

Dec 15, 2014 - Lorcaserin, combined with diet and exercise, can be used to produce additional weight loss, although the effect on morbidity and mortality is not known. It should be discontinued in patients who do not lose at least 5% of their body weight in the first 12 weeks because they are unlikely...

American Family Physician : STEPS

http://www.aafp.org/afp/2014/1215/p863.html

STEPS: Ivermectin Lotion (Sklice) for Head Lice - American Family Physician

Jun 15, 2014 - Topical ivermectin is safe, effective, and easy to administer because it involves only a single application-rinse cycle and does not require nit combing. However, it is significantly more expensive than nonprescription treatments and its benefits may not be worth the cost for most ...

American Family Physician : STEPS

http://www.aafp.org/afp/2014/0615/p984.html

STEPS: Roflumilast (Daliresp) for Chronic Obstructive Pulmonary Disease - American ...

Feb 15, 2014 - Roflumilast therapy has a limited role in patients with severe COPD, and no role in patients with mild to moderate COPD. It will not decrease the number of hospitalizations.

American Family Physician : STEPS

http://www.aafp.org/afp/2014/0215/p300.html

STEPS: Indacaterol (Arcapta) for COPD - American Family Physician

Aug 15, 2014 - Indacaterol provides a similar benefit to other long-acting bronchodilators for the treatment of moderate to severe COPD, with once-daily dosing. As with other LABAs, it should be used only as add-on therapy in patients already taking inhaled corticosteroids.

American Family Physician : STEPS

http://www.aafp.org/afp/2014/0815/p252.html

STEPS: Guanfacine (Intuniv) for Attention-Deficit/Hyperactivity Disorder - American ...

Feb 15, 2011 - Guanfacine is an effective short-term treatment option for ADHD in children six to 12 years of age. Sedation is a marked problem in many children. Patients should take the medication daily to avoid adverse effects that occur with abrupt discontinuation or when the guanfacine is restarted.

American Family Physician : STEPS

http://www.aafp.org/afp/2011/0215/p468.html

STEPS: Spinosad (Natroba) for Head Lice - American Family Physician

Jun 15, 2013 - Spinosad is safe and effective for the treatment of head lice; most patients will be lice-free after a single treatment. Nit combing following treatment is not necessary. These benefits must be weighed against its prescription-only status and higher cost compared with nonprescription ...

American Family Physician : STEPS

http://www.aafp.org/afp/2013/0615/p874.html

STEPS: Tapentadol (Nucynta) for Treatment of Pain - American Family Physician

May 1, 2012 - Tapentadol is a DEA schedule II opioid medication with a safety profile, duration of action, frequency of dosing, and analgesic effect similar to those of other oral narcotics, although it is more expensive. At low doses, immediate-release tapentadol is better tolerated than oxycodone ...

American Family Physician : STEPS

http://www.aafp.org/afp/2012/0501/p910.html

STEPS: Ticagrelor (Brilinta) for Secondary Prevention of Thrombotic Events Following ...

Dec 15, 2013 - Ticagrelor is an alternative to clopidogrel for secondary prevention of cardiovascular death in patients with acute coronary syndrome. In an international study it was found to be more effective, but patients in the United States did not experience superior outcomes.

American Family Physician : STEPS

http://www.aafp.org/afp/2013/1215/p821.html

STEPS: Emtricitabine/Tenofovir (Truvada) for HIV Prophylaxis - American Family Physician

Oct 15, 2013 - When used with a comprehensive HIV prevention strategy, emtricitabine/tenofovir effectively prevents HIV-1 infection in high-risk patients. Adherence to daily dosing is important to maintain protection. The cost of therapy may limit access, and not all insurance companies currently ...

American Family Physician : STEPS

http://www.aafp.org/afp/2013/1015/p535.html

STEPS: Vilazodone (Viibryd) for the Treatment of Depression - American Family Physician

Aug 15, 2013 - The available evidence does not support the routine use of vilazodone in the treatment of depression. It is significantly more expensive than generic alternatives and is no more effective for moderate to severe depression than selective serotonin reuptake inhibitors or tricyclic ...

American Family Physician : STEPS

http://www.aafp.org/afp/2013/0815/p263.html

STEPS: Fidaxomicin (Dificid) for Clostridium difficile Infection - American Family ...

Feb 1, 2013 - Fidaxomicin is effective for the treatment of C. difficile infection, but it is much more expensive than traditional therapy. Until it is known that the benefits outweigh the significant cost, metronidazole or oral vancomycin is the preferred treatment for most patients.

American Family Physician : STEPS

http://www.aafp.org/afp/2013/0201/p211.html

STEPS: Doxepin (Silenor) for Insomnia - American Family Physician

Aug 15, 2011 - In older patients with primary insomnia, Silenor can increase duration of sleep without next-day effects. However, it does not significantly decrease the time to sleep onset, and it is less effective in younger adults.

American Family Physician : STEPS

http://www.aafp.org/afp/2011/0815/p453.html

STEPS: Bromocriptine Mesylate (Cycloset) for Type 2 Diabetes Mellitus - American Family...

May 15, 2013 - Cycloset will lower A1C levels by 0.3 to 0.5 percent when taken alone or in combination with a sulfonylurea, without undesirable adverse effects such as hypoglycemia and weight gain. It will not cause further improvement of glucose control when used with insulin, metformin, or other ...

American Family Physician : STEPS

http://www.aafp.org/afp/2013/0515/p718.html

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