New drugs on Australia’s PBS schedule:

Alfuzosin:

• Xatral SR 10mg prolonged release tablets
• alpha-1 adrenergic blocking agent for use in Rx of benign prostatic hypertrophy, similar to prazosin, tamulosin and terazosin
• vasodilator so may cause postural hypotension
• only modest benefit over placebo and no difference in efficacy between the alpha-1 adrenergic blocking agents.

Clofarabine:

• Evoltra
• a purine nucleoside analague used in Rx of paediatric acute lymphocytic leukaemia

Melatonin:

• Circadin 2mg prolonged release tablets
• a natural hormone available for Rx of primary insomnia in those aged over 55 years
• only marginal benefits over placebo for most patients with only 30% responding

Nebivolol:

• Nebilet 1.25mg, 5mg and 10mg tablets
• beta1 blocker with mild vasodilatory properties via nitric oxide release
• used in Rx of hypertension (1.25mg up to max. 40mg once daily) and stable chronic heart failure (1.25mg, gradually increase to 10mg once daily if tolerated)
• benefits over other beta blockers are not yet clear clinically

Rizatriptan:

• Maxalt 10mg wafers
• Rx of acute migraine
• mainly acts as agonist on 1B and 1D serotonergic receptors
• more patients respond to 10mg rizatriptan than to 100mg sumatriptan, but headache was more likely to return and necessitate a 2nd dose after 2 hours
• overall efficacy is similar to sumatriptan

Ustekinumab:

• Stelara 45mg for injection
• a humanised monoclonal antibody which suppresses the immune system by blocking the inflammatory actions of IL-12 and IL-23, and is thus used in Rx of unresponsive psoriasis.
• a s/c dose is given at 0,4 and then every 12 weeks
• serious side affects include angina, stroke, hypertension, intervertebral disc prolapse, dactylitis, clavicular fracture, sciatica and nephrolithiasis, while one 33 yr old man died suddenly while taking a 90mg dose and the death was thought to be related to a dilated cardiomyopathy