Tools for Practice

Tools for Practice #392 Mission Slimpossible, Part 3: Tirzepatide for weight loss

Is tirzepatide effective for weight loss?

Tirzepatide 10-15mg/week results in ~15-20% weight loss versus 3% placebo at 72 weeks. Most patients on tirzepatide lose at least 10% body weight (78-84% versus ~20% placebo). Weight regain occurs when medication stopped. More weight loss occurs with tirzepatide versus semaglutide (~20% versus ~14%) based on one open-label, tirzepatide-sponsored randomized controlled trial (RCT). Read More

Tools for Practice #386 – The Bland Supremacy: Salt and cardiovascular disease

Does reducing sodium intake or substituting table salt with sodium-potassium alternatives improve cardiovascular outcomes?

Based on one large randomized, controlled trial (RCT) in patients with hypertension/previous stroke with above average daily salt intake (example 4.8 g/day), replacing table salt with a salt substitute may decrease mortality (from ~4.5% to ~4%) and stroke (from ~3.5% to 3%) per year. Whether reducing sodium by other means reduces mortality or cardiovascular events is unknown. Read More

Tools for Practice #383 – A single dose for treating yeast infections: Is it really this simple?

Does route or duration of antifungals matter when treating uncomplicated vulvovaginal candidiasis in non-pregnant women?

Route and duration do not impact efficacy; only a single dose of oral fluconazole or intravaginal antifungal (example clotrimazole) is needed. Patient preference should guide treatment choice. Read More

Tools for Practice #382 – Exercise for Parkinson’s Disease: More movement = Better movement?

How effective is exercise in Parkinson’s disease?

In patients with Parkinson’s Disease, exercise results in clinically meaningful improvements in motor symptoms similar to changes seen with medications (4-9 points better on a 108-point scale) compared to control over 1-6 months. It doesn’t provide clear improvements in quality of life. Six more patients out of 100 who exercise will avoid one or more falls over 6-12 months compared to control. Read More

Tools for Practice #381 – Pharm for Fibro, Round 2: Can gabapentinoids ease the pain?

Do gabapentinoids reduce pain in patients with fibromyalgia?

About 40% of people with fibromyalgia on pregabalin 300-600mg/day experience a meaningful reduction in pain (pain reduced by ≥30%) versus 30% on placebo at 8-14 weeks. Lower doses (example: 150mg) may not be effective; however, higher doses cause more harm, with up to ~30% of people stopping due to side effects (versus 10% on placebo). Based on one small randomized, controlled trial (RCT), gabapentin is also effective. Read More