Rofecoxib (Vioxx)--the first of a new generation of NSAIDs.

Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most frequently prescribed medicines in practice and, although of undoubted benefit for many, they are potentially toxic for some. Does rofecoxib, and the others which will inevitably follow, hold out the promise of safe and effective NSAID therapy in the future?

Temozolomide (Temodal) for treatment of primary brain tumours.

Although the outlook for patients with malignant gliomas continues to be very poor, progress in neurosurgery and radiotherapy, supported by new development in chemotherapy, offer some hope for the future. Temozolomide has recently been introduced by Schering-Plough Ltd (Welwyn Garden City, UK) as a new treatment which merits further investigation in this situation.

Palivizumab (Synagis) for prevention of respiratory illness in children.

Respiratory syncytial virus commonly causes infections that are of little consequence to most of us. However, for the newborn and at-risk older children, infection can mean serious, even life-threatening respiratory illness affecting pulmonary development and resulting in chronic chest disease. Palivizumab is a new medicine of the high-tech era designed specifically to prevent such problems. Its managed entry into clinical practice sets a challenge for health authorities across the country in ensuring most cost-effective delivery of health care.

Treatment of hepatitis C infection.

There is growing awareness of the health risk posed by hepatitis C virus and fears that an epidemic of 'AIDS proportions' may be just around the corner. As our understanding of the disease increases, it is likely that substantial resources will be spent on developing newer and more effective treatments for hepatitis C infection in the years ahead.

Sildenafil citrate (Viagra).

Sildenafil is the first of a series of orally active treatments for MED which has resulted in unprecedented demand for treatment and potentially high cost to the NHS. Further oral therapies are likely to follow in the next year or so. In clinical trials, sildenafil produced an erection (sufficient to achieve intercourse) lasting up to 4 h on around 70% of occasions. This was reduced to 50% in 'high-risk' groups (e.g. diabetics) and a placebo response in as many as 10-20% has been reported. Whether or not sildenafil should be prescribed at NHS expense has been more a matter for political, than clinical, debate. A clearer picture is now emerging with treatment available to those considered the 'most deserving' cases. The bigger picture is of impotence in large numbers of men with hypertension who are on antihypertensive therapy and have obvious small vessel disease. One option is to consign sildenafil to Schedule 10 (Black List) so that it is only available on private prescription. This would allay fears of the cost of treatment for those merely seeking to 'boost' already adequate sexual performance.

Analgesics in the management of chronic pain. Part five: Step 3 parenteral analgesic drug therapy.

This, the last article in the series, describes the administration of analgesics other than via the enteral route in the treatment of chronic severe pain.

Zanamivir (Relenza )--a new treatment for influenza.

Deaths from influenza are recorded every year in the UK and flu epidemics raise concerns for the safety of the young, the elderly and other vulnerable groups in the community. Not surprisingly, the launch of zanamavir (Relenza) by Glaxo Welcome (Middlesex, UK) has received much attention in the medical media and lay press. Just who should receive this treatment and under what conditions it should be given remains to be confirmed in practice.

Orlistat (Xenical).

The introduction of orlistat (Roche, UK) at the end of last year received considerable media coverage and was heralded in some quarters as the 'quick fix' for those wishing to lose weight without the pain of dieting. This description is far from accurate but treatment with orlistat may have a role in patients for whom obesity is a serious and even life-threatening condition.

New antibiotics for gram positive infections: linezolid and combination quinapristin/dalfopristin.

Considerable research over the past decade has thrown up two novel antibiotic preparations which are effective in 'difficult' Gram positive infections. Their imminent arrival is welcomed at a time when the emergence of resistance to last line drugs is rapidly spreading. Their careful use is, however, crucial if long-term value is to be preserved.

Analgesics in the management of chronic pain. Part Three: Step 2 analgesic drug therapy.

In this, the third article in the series, the role of analgesic drugs appropriate for the treatment of moderate to severe pain is reviewed along with therapies frequently applied in the treatment of poorly responsive neurogenic pain. The article should be read in conjunction with part one outlining general principles in the management of chronic pain.

Dornase-alfa (DNase, Pulmozyme) for cystic fibrosis.

Cystic fibrosis is a devastating illness affecting the young, in particular, and for which no cure exists. Any new treatment which might improve quality of life and prolong survival is to be welcomed but, so far, there are still several questions to be answered concerning the role of dornase-alfa.

Colony stimulating factors: G-CSFs--filgrastim (Neupogen) and lenograstim (Granocyte).

The introduction of leucocyte growth factors produced by DNA biosynthetic technology has had a major impact on survival in patients with compromised immunity. Such agents have maximized the benefits of treatment with drugs which are otherwise potentially toxic to the bone marrow.

Paracetamol poisoning.

Paracetamol is a common cause of fatal self-poisoning in the UK every year. Despite this, it continues to be sold freely without medical supervision and can be found in quantity in most household medicine cabinets.

Analgesics in the management of chronic pain. Part four: Step 3 oral analgesic drug therapy.

Reluctance to commence treatment with a Step 3 drug on the Analgesic Stepladder is a common reason for failure to manage chronic severe pain in many situations. The fourth article in the series reviews the potent opioid analgesics for oral use and in doing so addresses the various prejudices that surface when such therapy is denied.

Paracetamol poisoning.

Paracetamol is a common cause of fatal self-poisoning in the UK every year. Despite this, it continues to be sold freely without medical supervision and can be found in quantity in most household medicine cabinets.

Amphotericin intravenous preparations.

Alternative forms of amphotericin injection have been introduced in recent years. Though better tolerated and less toxic to kidney tissues, they are substantially more expensive than conventional amphotericin and their use is best reserved for specific indications.

Docetaxel (taxotere, Rhone-Poulenc Rorer).

Docetaxel is the latest in a new class of cytotoxic drug having a specific action on dividing cells. It is potentially a useful, if expensive, treatment for some common cancers in which the response to existing treatments has been generally disappointing.

Pamidronate (Aredia, Ciba) in malignant hypercalcaemia.

Hypercalcaemia is a disabling and lifethreatening complication in some patients with cancer. Bisphosphonates, including pamidronate, provide an effective means of lowering dangerously high calcium levels.