New drugs approved in 2025 are poised to significantly improve the management of motion sickness, acute pain, urinary tract infections (UTIs), and chronic spontaneous urticaria.
Gerald W. Smetana, MD, a professor emeritus of medicine at Harvard Medical School and Beth Israel Deaconess Medical Center in Boston, talked about new treatments in a presentation at the American College of Physicians Internal Medicine (ACP-IM) Meeting 2026 in San Francisco.
“This is the first time in my 15-year history of giving this new drugs talk that I’ve given all four drugs a thumbs-up, with the potential to change practice,” Smetana said during his presentation.
Making Headway Against Motion Sickness
Motion sickness is a common problem with limited solutions, Smetana said. In December 2025, the FDA approved tradipitant, a novel neurokinin-1 antagonist that is the first new medication approved to treat vomiting induced by motion in more than 40 years. It works by blocking discordant messages from sensory and vestibular centers that promote reflex nausea.
The approval was based on data from two phase 3 trials conducted on boats, in which the drug significantly reduced vomiting in participants with a history of motion sickness compared to placebo. In one study of 365 adults, about 18% and 20% of those who took 170 mg and 85 mg, respectively, of the drug daily experienced vomiting compared to approximately 44% of those who took placebo.
Whether those without a history of the condition would benefit from proactive treatment remains unclear, Smetana said. Tradipitant is expected to be available this spring.
While the final price has not yet been disclosed, estimated costs of more than $500 per eight-tablet bottle may be prohibitive and place it as a second-line treatment requiring prior authorization, Smetana said.
William Callahan, DO, a family medicine physician at Jefferson Health in Jenkintown, Pennsylvania, noted that the drug is not approved for the prevention of nausea.
Research is needed to compare the drug to the current standard, scopolamine transdermal treatment, and to understand how tradipitant treats nausea alone, Callahan told Medscape Medical News.
“The clear benefit of tradipitant is its safety profile, with no reported anticholinergic side effects,” Callahan said.
Non-Opioid Tackles Acute Pain
Suzetrigine targets the peripheral sensory nerves and dorsal root ganglia, reducing incoming pain signals, Smetana said. The drug represents the first new class of non-opioid pain medication in decades.
The approval of the drug for acute postoperative pain was supported by data from two phase 3 studies that involved adults undergoing bunionectomy or abdominoplasty.
Patients randomly assigned to a 48-hour course of suzetrigine showed a significantly shorter time to a reduction in their pain score than patients assigned to receive placebo.
However, efficacy and safety for subacute and chronic pain are unknown, and data for use beyond 14 days are lacking.
Notably, the studies used hydrocodone bitartrate/acetaminophen for comparison, and suzetrigine performed similarly, Callahan said.
“This is huge: a non-opiate providing opiate-level pain control,” he said.
Gepotidacin: Greater Infection Coverage
Epidemiologic data show that approximately one third of women in the US experience at least one UTI that requires antibiotics, Smetana said.
Not all patients respond to first-line therapies, which include nitrofurantoin monohydrate, trimethoprim-sulfa, and cefpodoxime, Smetana said. The new drug gepotidacin works by blocking the activity of two bacterial topoisomerases and was approved to treat uncomplicated UTI by the FDA in March 2025.
In studies that supported approval, gepotidacin was noninferior to nitrofurantoin. Cure rates in cases of resistant Escherichia coli were also higher for patients treated with the new drug than for those treated with nitrofurantoin. Clinicians may consider using the new drug in cases of known or suspected resistant bugs, Smetana said during his presentation.
The main barrier to expanding use of gepotidacin may be the high cost of nearly $2000 for a 5-day course, Callahan said. And manufacturer cost assistance is only available to those with commercial insurance. With those considerations, the drug will likely be reserved for patients with documented resistance patterns or allergies that require this medication, he said.
Top Dollar for Clearer Skin
Remibrutinib, a selective tyrosine kinase inhibitor given orally, offers an option to help clinicians manage refractory chronic spontaneous urticaria in primary care, Smetana said. The drug was approved in September 2025. The condition, characterized by recurring hives or wheals for at least 6 weeks, is distinct from the physical urticaria caused by heat or skin pressure, he said.
In two studies, patients treated with remibrutinib showed significant improvement in urticaria activity from baseline to 24 weeks with twice-daily dosing at 25 mg, showing sustained improvements for up to 1 year.
No new safety concerns appeared, but given a theoretic potential for effects on the risk for infection, more postmarketing safety data are needed beyond 52 weeks, Smetana said.
The drug may be preferable to patients who would choose oral treatment over injectable biologics despite the higher estimated 30-day cost of $4521 for remibrutinib vs $1472 for omalizumab and $3992 for dupilumab, he said.
Callahan said chronic spontaneous urticaria can be difficult to treat, with significant trial and error needed to identify the best option for a patient, he said.
“Many primary care practices are not set up to administer injectable biologic treatments, which makes this medication important,” he said. “Further studies will be needed to compare remibrutinib to the current standards of care, specifically biologics, which would likely determine where it falls along the pathway of treatment.”
Smetana and Callahan reported having no relevant financial conflicts.
https://www.medscape.com/viewarticle/new-drugs-are-primary-care-game-changers-pricey-2026a1000cg6
