New Treatment Approved for Head Lice

Nothing makes your head itch like hearing someone has head lice! Immediately, we all cringe and reach up for a quick scratch. Who gets lice? Primarily grade school aged girls (5-11 years old). Girls that age live with their heads tightly paired up with their best friends, sharing hairbrushes, pillows, headbands and hats. Certainly boys get lice, too, and people of all ages are susceptible. In the United States alone, we have between 6-12 million cases per year!

Lice come in two flavors- head lice and pubic lice- and they do not jump from one body part to another. Head lice stick to scalps, and pubic lice attach to the coarse pubic hair, or possibly coarse underarm, mustache, or eyebrow hairs. Lice are obligate parasites, requiring humans for their life cycle. The adults are 1-3mm long (so they are visible to the naked eye.) Most often, lice are recognized by seeing nits, which are the eggs that attach to hair near the base of the shaft. They look like tiny clear or white ovals stuck on the hair, and they will not be easily detached (as opposed to flakes of dandruff, which you can flick off easily.)

Lice can be treated with a couple different over-the-counter products- Rid and Nix. These products kill the adult lice, but not the eggs, so typically treatment is repeated one week after the initial treatment. There are also special combs that help to physically remove the nits from the hair. The FDA has recently approved another lotion called Sklice, with that active ingredient being ivermectin. (You might recognize this medication from your pet, as ivermectin is used to prevent heartworm.) The apparent advantage is that only one ten minute application resolves most lice infestations without the need to remove the nits.


Is Sklice better than the products we already have? Maybe, but we don't have any head-to-head comparison studies yet (pardon the pun.) Certainly, if it reduces or eliminates the need to "nit-pick", this will represent a very significant advantage over our existing treatments.

BOTTOM LINE: If you or your child get head lice, talk to your doctor about the treatment options, including the newly approved Sklice. (Note that Sklice will not be available in pharmacies for another couple of months.)

Brand New FDA- Approved Antidepressant

The stock market is very aware that the FDA has approved a new antidepressant (see the FDA News release here)- a drug called Viibryd (vilazodone hydrochloride.) The manufacturer claims that this antidepressant did not cause weight gain, nor did it affect sexual function. If that turns out to be true once large numbers of people are taking the medication, I know I will be flooded with requests for this drug, because weight gain and decreased libido or sexual function are the major complaints that I hear about this class of medications.
Before we all jump on the bandwagon, however, let's go back to a blog I did last week- "Doc, Have you heard of this new drug" and look at the "STEPS" pneumonic.
S: Safety-Side affects appear to be at reasonable incidence, and I cannot find information regarding drug interactions.
T: Tolerability- side effects include "diarrhea, nausea, vomiting and insomnia"
E: Effectiveness-Honestly, I cannot tell from a brief perusal of the medical literature. I found many studies in rats, from the years leading up to the human trials, but only one good size (400 patients) of humans. There was some effect at one week (which is early for anti-depressants) compared to placebo, but no studies yet comparing it to other antidepressants.
P: Price- Don't know yet, but it's a new drug. This means coupons the first year, but a new drug is always a higher price than old ones. The business world, however, is excited and projecting over $2 MILLION in sales.
S: Simplicity- Sounds like it will be once per day, though again, I never found a product information sheet.

BOTTOM LINE: Yes, there is a new antidepressant, which MAY provide good improvement in patients with major depression, while having fewer adverse side effects (weight gain and sexual dysfunction)...but let's not storm the pharmacy yet.

Doc, Have You Heard of This New Drug?

Often patients ask me about a new drug they heard or read about, and would like a prescription to "try it out". Sometimes, the new drug works wonders, but most of the time, there is no such luck. Obviously pharmaceutical companies are spending more money on direct advertising to the public, and it's working! Our country spends staggering amounts of money on drugs.
Today I'd like to share a pneumonic from the AAFP that helps doctors assess new medications: STEPS.

S: Safety- what are the drug interactions and side effects?
T: Tolerability- how many people stop taking the drug because of side effects?
E: Effectiveness-this may seem obvious, but really: does this drug not only change a LAB VALUE (or blood pressure, etc.) but DOES IT IMPROVE PATIENT QUALITY OF LIFE or HELP PATIENTS LIVE LONGER?
P: Price: Is it worth the cost?
S: Simplicity: How many times per day is it required? With or without food? Can it be taken with other medications?

BOTTOM LINE: Together with your doctor, discuss these issues before you add another medication to your daily routine. </span>

New Weight Loss Drug in the New England Journal!

PLEASE do not ask me for this drug! I cringe every time that there is media attention to a new weight loss drug. This is not rocket science! If you read the study in the New England Journal of Medicine, ultimately this is what you will see:

1. All the participants received nutrition counseling and behavior modification in addition to the drug.
2. Yes, the folks on the test drug (Lorcaserin) lost more weight than placebo.
3. The people on the drug lost an average of roughly 12 pounds in ONE YEAR (note-one pound per month), and the placebo group lost an average of almost 5 pounds.
4. Everyone was relieved that there were no serious heart valve issues.
5. Side effects include: headache, dizziness and nausea.

Good weight loss from improving the quality of your diet (more fruits and veggies) and starting to exercise regularly is one half to one pound per week- so 2-4 pounds per month, or 50 pounds or more in a year. Side effects? Let's see- you feel better, have more energy, and bonus- don't mind looking in the mirror.

Please stop looking for a magic pill! All medications have side effects, and this new weight loss pill is no exception.
BOTTOM LINE: Old fashioned fruits, vegetables and exercise yield better weight loss with fewer side effects! Spend your money on MIchelle May, MD's book: Eat What You Love, Love What You Eat and break out of your "eat-repent-repeat" eating cycles!