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Abstract Cholestagel: new adjunct for hyperlipidaemia A new bile acid sequestrant has been introduced as an adjunct to a statin and diet to reduce total and LDL‐cholesterol, or as monotherapy when a statin is inappropriate or poorly tolerated. By binding to and depleting bile acids, colesevelam (Cholestagel) increases hepatic conversion of cholesterol to bile acids leading to a reduction in serum LDL‐cholesterol. When added to treatment with a statin, colesevelam further reduces LDL‐cholesterol levels by 8‐16 per cent. Common adverse effects include constipation and dyspepsia; myalgia has also been reported. A month's treatment with colesevelam at the recommended dose of 2.5‐3.75g per day (four to six tablets) costs £58‐£86. CV risk similar for diclofenac and coxibs The risk of cardiovascular events during treatment with diclofenac 150mg daily is probably similar to that associated with the coxibs, the National Prescribing Centre says ( MeReC Extra 2007;No. 30). The coxibs are associated with an excess risk of CV events of about 3 per 1000 patients treated per year. The highest licensed dose of diclofenac probably carries a similar risk, whereas ibuprofen at a dose up to 1200mg daily and naproxen 1000mg daily are associated with a lower risk. Patients taking high‐dose diclofenac who want to reduce their GI risk may consider switching to low‐dose ibuprofen or, with the addition of a proton pump inhibitor, naproxen. Topical NSAIDs approved Topical NSAIDs, once unpopular with prescribing advisers, are now being proposed as a ‘useful alternative’ for the over‐50s with chronic knee pain. UK investigators have found only a minor difference in efficacy between topical and oral ibuprofen in patients with knee pain of at least three months' duration ( BMJ Online: 4 Dec 2007; doi:10.1136/bmj.39399.6563 31.25). Oral administration was associated with a greater effect on renal function and more adverse respiratory effects (reduced peak flow). MHRA warning on varenicline safety The MHRA warns that the smoking cessation treatment varenicline (Cham‐pix) may impair driving skills and has been associated with depression. The Agency's latest safety bulletin ( Drug Safety 2007;1: Issue 5; www.mhra.gov.uk ) states that wider clinical experience has confirmed the common adverse effects reported in clinical trials, notably nausea, headache and vomiting, but also abnormal dreams and somnolence. After an estimated 15 000‐20 000 patients had been treated, the MHRA received 46 reports of depression associated with varenicline (mostly in patients with a psychiatric history) and 16 reports of suicidal ideation. Other topics covered in this issue of Drug Safety include advice that treatment with dosulepin should be initiated by a specialist, safe prescribing of erythropoietins, summaries of safety issues with the glitazones and NSAIDs, and a reminder that short‐acting beta‐agonists may cause myocardial ischaemia. Asthma guideline update SIGN is consulting on proposed updates to its joint guideline on the management of asthma. Three sections have been revised ‐ diagnosis and monitoring, nonpharmacological treatment and pharmacological treatment ‐ and there is a new section on difficult asthma. Copyright © 2008 Wiley Interface Ltd.