User:DCDuring/Drugs of last resort


 * amikacin
 * amphotericin B
 * carbapenems—used as drug of last resort for a variety of different bacterial infections. Resistance is currently spreading to this last-resort drug, potentially producing bacteria that are resistant to all currently developed antibiotics.
 * chloramphenicol—formerly first-line therapy for Rocky Mountain Spotted Fever (until doxycycline became available). Also first-line therapy (used topically) for bacterial conjunctivitis, and systemically for meningitis when allergies to penicillin or cephalosporin exist. Unacceptably high risk of irreversible, fatal aplastic anemia and gray baby syndrome causes systemically administered chloramphenicol to be a drug of last resort.
 * cisapride
 * clozapine —used in treatment-resistant schizophrenia not responsive to at least two different antipsychotics; the main reason for such restriction is agranulocytosis and other severe side effects including seizures and myocarditis.
 * colistin
 * imipenem/cilastatin
 * linezolid
 * levosimendan—used in acutely decompensated severe chronic heart failure in situations where conventional therapy is not sufficient.
 * milrinone
 * Oral minoxidil for hypertension, however topical minoxidil is the first line drug for hair loss.
 * polymyxin antibiotics.
 * thalidomide—withdrawn in 1961 owing to widespread incidence of severe birth defects (phocomelia and absence or truncation of limbs) after prenatal use by pregnant women, US Food and Drug Administration approved thalidomide for erythema nodosum leprosum (ENL) in 1998, and 2008 for new cases of multiple myeloma (administered with dexamethasone). A large "off-label" business in thalidomide began for "orphan" cancers and other rare conditions even while it was only FDA-approved for erythema nodosum leprosum.
 * tolcapone—used in patients with Parkinson's disease who are not appropriate candidates for other adjunctive therapies. Use is restricted due to high chances of hepatotoxicity.
 * vancomycin—while this is a very well-tolerated antibacterial, its usefulness only as an injectable and potency in treatment of infection with multiple drug-resistant organisms has caused a growing trend to reserve it for these uses to avoid the spread of vancomycin resistance (in hopes that it will remain useful in intensive care units and other settings where methicillin-resistant staphylococcus aureus (MRSA) and other drug-resistant organisms are a problem).
 * vigabatrin—used in treatment-resistant epilepsy due to the risk of irreversible vision loss.