著者

赤木 祐貴 荒井 碧 下村 斉 山本 康次郎 青山 隆夫

出版者

一般社団法人日本医療薬学会

雑誌

医療薬学 (ISSN:1346342X)

巻号頁・発行日

vol.41, no.6, pp.404-414, 2015-06-10 (Released:2016-06-10)

参考文献数

37

被引用文献数

1 1

---

Low-dose aspirin inhibits cyclooxygenase-1 (COX-1) on platelets irreversibly, suppressing platelet aggregation.Nonsteroidal anti-inflammatory drugs (NSAIDs) also inhibit COX-1 reversibly by forming a salt bridge. However, there is little information on the antiplatelet effects of the chronic use of NSAIDs (other than aspirin). We performed pharmacokinetics/pharmacodynamics (PK/PD) analysis using in vitro experimental data obtained when NSAIDs were added to human blank blood, and estimated the antiplatelet effects of continuous NSAID administration.Ibuprofen, diclofenac, indomethacin and loxoprofen were studied in a one-compartment model, and etodolac was studied in a two-compartment model. Platelet aggregation was measured after adding NSAIDs to platelet-rich plasma at a range of concentrations containing the maximum plasma concentrations of one clinical dose. We calculated the platelet-aggregation threshold index (PATI) as an index of aggregation activity, which was defined as the putative stimulus concentration giving 50% aggregation, and performed PD analysis according to the sigmoidal Emax model. Simulated time-PATI curves of NSAIDs were compared to that of low-dose aspirin.Simulated values of increase in PATI for the maximum plasma concentration of each NSAID were lower than 3.9 µg/mL, which is the same as that of low-dose aspirin. Increases in PATI around the trough concentration were nearly zero for all NSAIDs except ibuprofen, thus suggesting that the antiplatelet effects of continuous NSAID administration are weaker and less persistent than those of low-dose aspirin. The simulation results indicate that continuous NSAID administration is less effective at preventing thrombosis and embolism than low-dose aspirin, and postoperative NSAID treatment needs to be careful of the occurrence of bleeding.

著者

鹿村 恵明 大山 明子 高橋 淳一 赤木 祐貴 根岸 健一 伊集院 一成 上村 直樹 青山 隆夫

出版者

公益社団法人 日本薬学会

雑誌

YAKUGAKU ZASSHI (ISSN:00316903)

巻号頁・発行日

vol.132, no.6, pp.753-761, 2012-06-01 (Released:2012-06-01)

参考文献数

18

被引用文献数

13 8

---

This study examined the impact of pharmaceutical inquiries regarding prescriptions on drug costs by surveying the actual condition of inquiries at 13 pharmacies. The study also investigated the significance of inquiries from a medical economics perspective by calculating the medical cost savings realized by preventing adverse drug reactions (ADRs). As a result, the total change in drug costs for the 13 pharmacies after pharmaceutical inquiries represented an increase of ¥9,018/month. However, upon recalculating the cost of drugs by assuming that those with an “Incomplete entry in the prescription (compared with previous prescription, etc.)” should in fact have been prescribed, and excluding them, the total drug costs for the 13 pharmacies is decreased to ¥154,743/month, translating to a cost-savings of ¥7.2/prescription. The study then undertook a comprehensive assessment based on the Diagnosis Procedure Combination (DPC) system to determine the total medical cost-savings for 5 patients in whom ADRs could have occurred if the prescriptions had not been modified as a result of pharmaceutical inquiries. The obtained figure of ¥1,188,830 suggests that pharmaceutical inquiries contribute to reduced medical costs. The findings of this study indicate that pharmaceutical inquiries regarding prescriptions by staff pharmacists not only ensure the proper delivery of drug therapy to patients, but are also effective from a medical economics perspective.