著者

郷 真貴子 川地 志緒里 宇佐美 英績 木村 美智男 吉村 知哲

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.44, no.6, pp.280-287, 2018-06-10 (Released:2019-06-10)

参考文献数

18

被引用文献数

3

---

A pharmacist outpatient service for patients receiving monotherapy with oral anticancer drugs aims to improve safety and medication continuation through pre-examination interviews. We assess medication adherence and monitor chemotherapy-induced adverse events by referring to patientsʼ complaints of symptoms and their medical diaries. In addition, “unused prescribed medicines” can also be a useful information resource. However, unused medicines are becoming a large-scale problem in Japan, thus leading to lower therapeutic effects and higher healthcare costs. In this study, we interviewed 270 patients (cumulative total: 1,385, monthly average: 153.9) from January 1 to October 31, 2017. Adjusted numbers of unused anticancer drugs were 96 and those of unused medicines for supportive care were 420, including moisturizing creams and steroidal ointments (23.1%), antidiarrheal drugs (18.1%), and antiemetic drugs (8.1%). We calculated the reduction in healthcare costs as JPY 5,045,585.5 (monthly average: JPY 560,621) for all unused medicines and as JPY 4,699,791.6 (monthly average: JPY 522,199) for only unused anticancer drugs. Anticancer drugs went unused because of chemotherapy-induced adverse events (grade 1: 37.3%, grade 2: 60.8%, grade 3: 2.0%) and failure to take them as prescribed. However, the chemotherapy discontinuation rate caused by adverse events was only 6.8% through our continuous interventions. Chemotherapy with oral anticancer drugs needed to be discontinued appropriately in cases of developing grade≧2 adverse events; therefore, unused medicines exist. This pharmacist outpatient service can also lead to major reductions in healthcare costs through management of unused medicines.

著者

永光 加奈 田辺 公一 後藤 伸之 大津 史子

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.44, no.7, pp.370-379, 2018-07-10 (Released:2019-07-10)

参考文献数

7

被引用文献数

2

---

We investigated the current situation of pharmacists' recognition of and countermeasures they take against adverse drug reactions (ADRs) in order to elucidate related factors. We administered a web-based questionnaire to pharmacists who work at community pharmacies. The factors included in the questionnaire were basic information, recognition of and countermeasures against ADRs (the frequency of ADR recognition, investigation medium, the recognition of and countermeasures against ADRs and reasons for those). There were 29 questions about ADR education in total. In this study, we focused on the frequency of ADR recognition and countermeasures taken against ADRs, and examined their current status and related factors. As a result, after performing multivariable logistic regression analysis, we found that the group of pharmacists who made prescription inquiries about patients had an association with the investigation medium they used and are likely to investigate actively. Our results suggest the possibility that many pharmacists differed in their knowledge about the onset and recognition of ADRs. Moreover, our results found situations where prescription inquiries were actively made, but ADRs were not adequately reported. In conclusion, pharmacists who make prescription inquiries are likely to investigate and actively use information media, and this suggests the necessity of selecting the appropriate information medium and critically examining information. However, since those who answered our survey were biased towards the young, it is necessary to consider the possibility that this influenced the results.

著者

中村 一仁 浦野 公彦 田中 万祐子 西口 加那子 堺 陽子 片野 貴大 鍋倉 智裕 山村 恵子 國正 淳一

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.40, no.9, pp.522-529, 2014-09-10 (Released:2015-09-10)

参考文献数

10

被引用文献数

5 11

---

This study examined the reduction in medical expenses achieved by pharmaceutical inquiries at a community pharmacy. The total number of inquiries was 1,053 out of a total of 29,875 prescriptions filled at one community pharmacy (incidence: 3.5%). Pharmaceutical inquiries regarding the elimination of prescribed medicines were classified into two categories: leftover (incidence: 0.76%) and those regarding duplicate prescriptions filled by other institutions or drug interactions (incidence: 0.18%). The doctors accordingly reduced the number of medicines after these inquiries, which led to a reduction in dispensing and medical fees. The reduction in patient medical expenses per prescription from leftover medicines was 1,425 yen (median) for children (under 14 years), 390 yen for adults (15-64 years), and 1,165 yen for elderly patients (over 65 years). The reduction in patient medical expenses per prescription from eliminating duplicate prescriptions was 955 yen for children, 250 yen for adults, and 360 yen for the elderly. The reduction in patient medical expenses from leftover medicines was statistically higher compared with that from duplicate prescriptions for elderly patients (P < 0.01). This difference was because of long-term drug prescriptions for cardiovascular diseases and diseases of the digestive and central nervous systems. Our findings show that community pharmacists can effectively reduce patient medical expenses and increase patient safety by responding to pharmaceutical inquiries and collecting leftover medications.

著者

面谷 幸子 名徳 倫明 山城 美樹 長谷川 渚彩 大橋 甲三郎 長井 克仁 西井 諭司 初田 泰敏 小川 雅史

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.42, no.1, pp.31-39, 2016-01-10 (Released:2017-01-10)

参考文献数

10

---

Workshops on the use of adrenaline auto-injection (EPIPEN), reconsideration of training programs on food allergies, and an approach to increase risk awareness of food allergies are required. We investigated the current state of education of school teachers and school pharmacists in Tondabayashi City.A total of 120 school teachers and 14 school pharmacists participated in our questionnaire. More than 90% of teachers had experience with children with allergies, and more than 95% of teachers were aware of anaphylaxis. Although most teachers were familiar with EPIPEN, they did not have detailed knowledge and were not confident in using it in an emergency. School teachers who attended EPIPEN workshops had a higher degree of confidence in using EPIPEN in an emergency than school teachers who do not attended the workshops. Attending workshops will increase the self-confidence of teachers in using EPIPEN in an emergency. The survey results indicate that it is important for school pharmacists to hold regular workshops on EPIPEN, including practical training, to develop the EPINEN skills of school teachers and enlighten them on the subject.

著者

中本 恵理 川上 和宜 今田 洋司 式部 さあ里 杉田 一男 篠崎 英司 末永 光邦 松阪 諭 水沼 信之 濱 敏弘

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.37, no.7, pp.403-409, 2011 (Released:2012-08-30)

参考文献数

16

被引用文献数

1 3

---

Cetuximab, a therapeutic agent for metastatic colorectal cancer, is a chimeric monoclonal antibody that binds and inhibits the epidermal growth factor receptor (EGFR). Adverse events associated with cetuximab include skin disorders, which occur at a high incidence, infusion reactions, and electrolyte disorders, such as hypomagnesemia. The incidence and time of onset of hypomagnesemia following the start of cetuximab treatment were investigated retrospectively. The efficacy of oral magnesium preparations in preventing hypomagnesemia was also examined.At The Cancer Institute Hospital of Japanese Foundation For Cancer Research, the incidence of hypomagnesemia in patients treated with cetuximab was 39.3%. However, there was no clear trend in the time of onset. In addition, there was no difference in the incidence of hypomagnesemia as a function of whether oral magnesium preparations were administered (p=0.097). Some patients developed severe hypomagnesemia and an intravenous magnesium preparation was not very effective in bringing about recovery, necessitating discontinuation of cetuximab therapy.Mild hypomagnesemia may be overlooked because subjective symptoms are not readily apparent. However, if it worsens, hypomagnesemia may lead to serious adverse events, such as arrhythmias, which would require discontinuation of cetuximab treatment. In pa tients receiving cetuximab, therefore, serum magnesium levels must be monitored regularly since early detection and treatment of hypomagnesemia are very important.

著者

板垣 文雄 工藤 千恵 片桐 幸子 忍足 鉄太 高橋 秀依 夏苅 英昭 渡邊 真知子

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.39, no.9, pp.521-527, 2013-09-10 (Released:2014-09-10)

参考文献数

13

被引用文献数

4 4

---

After meropenem hydrate (MEPM) injection and amino acid infusions are mixed, the MEPM residual ratio sequentially decreases. This incompatibility is probably due to the nucleophilic attack on the β-lactam ring of MEPM by L-cysteine (L-Cys) present in the amino acid infusion. This study aims to identify the influence of L-Cys on the reaction between MEPM injection and amino acid infusions through an initial incompatibility test between MEPM and L-Cys at pH 4 to 8, followed by an incompatibility test between MEPM injection (MEPM plus additives) and 18 types of amino acid infusions. In the MEPM and L-Cys incompatibility test, as the pH increased, the MEPM decomposition speed was observed to increase after mixing of the two components. This reaction progressed as a secondary reaction, the linear relationship between pH and the logarithm of secondary reaction speed constant, k2, was established (ln k2 = 1.632 × pH - 15.631, r2 = 0.998). In the incompatibility test between MEPM injection and amino acid infusions, as the concentration of L-Cys increased, the MEPM residual ratio was observed to decrease. At 10 and 30 minutes after the mixture of components, a strong correlation was observed between the estimated MEPM residual ratio from the reaction velocity and the measured value (10 minutes: r2 = 0.985, RMSE: 5.44%; 30 minutes: r2 = 0.986,RMSE: 4.55%). The results above indicate that the residual ratio of MEPM obtained through the L-Cys incompatibility test matches the measured residual ratio of MEPM using the MEPM injection and amino acid infusions. Therefore, L-Cys has been identified as the main cause of incompatibility between MEPM injection and amino acid infusions.

著者

水上 恵美 小田 晃司 番場 孝 野中 潤 今井 明 古川 征治

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.28, no.6, pp.559-563, 2002-12-10 (Released:2011-03-04)

参考文献数

22

被引用文献数

1

---

The concomitant use of oral iron preparations and antacids causes iron to form macromolecular polymer thereby reducing its absorption as a result of a pH elevation in the stomach. We measured the Iron recovery after ultrafiltration to assess macromolecular polymer using sodium ferrous citrate (SFC) and ferrous sulfate (FS) preparations plus eight types of antacids Aluminum hydroxide (Al), Magnesium oxide (Mg), Calcium carbonate (Ca), and Sodium bicarbonate (NaHCO3) preparations and four combinations.The samples were mixed under two conditions : (1) a mixture of the maximum single oral dose of each iron preparation and an antacid dissolved in a hydrochloric acid solution adjusted to various pH levels (4, 5, 6, 7, 8, and 9) (2) pH not adjusted. Iron recovery rate was measured using the O-phenanthroline method after ultrafiltration (fractions with a molecular weight of 10, 000).As a result, we obtained the following results : (1) the iron recovery rate decreased according to elevation of pH. In addition, macromolecular polymer formation was pH dependent. The iron recovery rate of FS when mixed with all antacids except Mg was less than 60 % at a pH of 7. The iron recovery rate of SFC was not less than 60% at a pH of 7 with any antacid. (2) the iron recovery rate of FS when mixed with Ca, NaHCO3, the Al + Mg combination and Mg was less than 60%. The iron recovery rate of SFC was less than 60 % with only Mg.FS formed macromolecular polymer in the presence of Ca, NaHCO3, the Al+Mg combination and Mg. As a result, the iron absorption was suggested to decrease when FS was administered with these antacids. SFC showed little formation of macromolecular polymer in the presence of antacids, and it was therefore suggested that the absorption would only be slightly influenced by the concomitant use of SFC with antacids. Therefore, the formation of macromolecular polymers differed between the two oral iron preparations, FS and SFC, when mixed with antacids. These findings suggest that iron absorption may differ between FS and SFC in concomitant use with antacids.

著者

内田 昌希 浦山 玲菜 一色 恭徳 八巻 努 前野 拓也 上田 秀雄 近藤 誠一 夏目 秀視

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.40, no.2, pp.109-116, 2014-02-10 (Released:2015-02-10)

参考文献数

19

---

In the present study, 0.5% povidone-iodine solution was prepared aseptically using various commercial products of 10% povidone-iodine solution, and the stability of 0.5% povidone-iodine solution after storage under various conditions was evaluated. Furthermore, a comparison between various commercial products was also performed. As a result, the stability of available iodine in 0.5% povidone-iodine solution was found to be affected by light, temperature and the sealability of the container. Of the storage methods investigated in the present study, the method of keeping the highest available iodine concentration was to store the povidone-iodine solution in a closed container under a light-shielded state at 4°C. The term of validity was 3 or 4 weeks in Hisiiode disinfectant solution or other products (Isodine® solution, Popiyodon solution, Negmin® solution, Popyral disinfectant solution and Iodine M disinfectant solution), respectively in storage in a closed container under a light-unshielded state at room temperature, which was the usual method of a disinfectant, from the results of a stability test of available iodine in 0.5% povidone-iodine solution. It was confirmed that bactericidal activity was maintained until at least 4 weeks after preparation in every commercial product from the results of a bactericidal activity test on the solution in the usual storage method (Staphylococcus aureus, Bacillus subtilis, Escherichia coli, Pseudomonas aeruginosa, Aspergillus niger, Candida albicans). Of the 0.5% povidone-iodine solution investigated in the present study, Popiyodon solution and Negmin® solution kept the available iodine comparatively stable under each storage condition.

著者

丸山 穂高 三宅 真二 黒川 達夫

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.42, no.7, pp.499-511, 2016-07-10 (Released:2017-07-10)

参考文献数

9

被引用文献数

3 1

---

Increases in national healthcare costs are heightening concerns for Japanese society. In recent years, the development and utilization of biosimilars (BSs) has become an area of focus because they are 23-30% cheaper. However, the use of Infliximab BS does not necessarily ensure the reduction of patient payments in Rheumatoid Arthritis (RA) cases. This paradox adversely affects the wider use of Infliximab BS. Its market penetration in Japan is less than 1%. This may indicate a significant loss for the both national healthcare scheme and patients. It is critical to identify the causes and possible remedies. We conducted a study with simulated one-year RA patient models and calculated total monthly payments for Infliximab BS and branded biologics (BBs).Problems arise when three conditions are met: patient’s age under 70, annual income of 3.7 million yen or less, and three-dose vials daily. The main contributor to this situation is the High-Cost Medical Expense Benefit, which covers monthly payments exceeding a specified amount. This system applies to Infliximab BB users. The estimated number of patients who meet all three conditions is around 1,305 about 8% of RA patients treated with Infliximab. This shows that the majority of patients (92%) benefit from using Infliximab BS. Therefore, we do not feel that total abandonment of Infliximab BS use is justified. Our findings support that the High-Cost Medical Expense Benefit has to be adequately modified, so that BS users do not pay more for treatment than BB users.

著者

磯野 哲一郎 國津 侑貴 増田 恭子 平 大樹 荒木 久澄 荒木 信一 宇津 貴 寺田 智祐

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.43, no.11, pp.601-609, 2017-11-10 (Released:2018-11-10)

参考文献数

29

被引用文献数

1 3

---

The proper use of drugs with renal excretion and nephrotoxicity is an urgent problem due to the increase in CKD patients. We have been sharing renal function data on CKD patients among medical staff, including community pharmacists, using the CKD sticker since March, 2012 in Shiga. The CKD sticker is affixed to the medication log book of CKD patients. We performed questionnaire surveys of all community pharmacies in Shiga for five years from 2012 to 2016, and examined the utility of the CKD sticker. The CKD sticker was recognized at 98.6% of pharmacies in 2016. Pharmacies attended by patients with the CKD sticker increased to 68.8% in 2016. In addition, there were no local differences among 9 branches in the Shiga Pharmacist Society in 2016. The number of pharmacies that performed questionable inquiries based on the CKD sticker increased from 7.7% in 2012 to 24.7% in 2016. Pharmacies that inquired about patients with CKD stickers greatly increased in 2016, and the number of prescription changes increased. The spread of CKD stickers was observed throughout the prefecture, and this study demonstrated that the CKD sticker was a useful tool for questionable inquiries. The CKD sticker helped to avoid the use of drugs in cases with nephrotoxicity and to reduce the quantity of drugs in cases with renal excretion, allowing for safe medication of CKD patients.

著者

松岡 紗代 三木 晶子 佐藤 宏樹 堀 里子 澤田 康文

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.38, no.9, pp.592-598, 2012-09-10 (Released:2013-09-12)

参考文献数

9

被引用文献数

5 5

---

Non-steroidal anti-inflammatory drug (NSAID) patches tend to be prescribed in larger amounts than are actually used and surplus patches are often kept at patients' homes. Improper use of these patches without the advice of healthcare professionals might result in serious adverse effects. This study investigated patients' opinions and requests regarding the prescribed amount of NSAID patches, and their intended use of surplus patches. A web-based questionnaire survey was conducted on patients who had been prescribed NSAID patches within the previous year. There were 618 respondents. Patients who described the amount of patches prescribed as “just the amount needed" and “quite or somewhat excessive" amounted to 41%and 40%of the respondents, respectively. Forty-three-percent of respondents had at some time requested a larger prescribed amount or an additional prescription. Sixty-four-percent of them received the prescription they requested. Also, 61 % of respondents had unused NSAID patches at their homes, and many of them intended to use these patches as they felt necessary. Patients who believed that NSAID patches do not induce side effects amounted to 24%, while 54%of patients had at some time suffered symptoms possibly due to systemic or local side effects of NSAID patches. Considering the above results, healthcare professionals should provide suitable and sufficient information about NSAIDs patches to patients, and take steps to minimize the numbers of unused patches remaining at the patients' homes in order to avoid improper use of NSAID patches and to reduce medication costs.

著者

冨田 猛 山本 和宏 山下 和彦 大本 暢子 槇本 博雄 矢野 育子

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.45, no.12, pp.698-705, 2019-12-10 (Released:2020-12-11)

参考文献数

15

---

We began to print the laboratory data of each patient on their in-hospital prescription in April, 2010 and further introduced a prescription checking system associated with laboratory data in December, 2014. This study evaluated the changed prescriptions based on prescription queries and the usefulness of using prescriptions with laboratory data as well as the prescription checking system. We examined the number of changed in-hospital prescriptions after the prescription queries in three periods: before and after using prescriptions with laboratory data (from June, 2009 to November, 2009 and from June, 2010 to November, 2010, respectively), and after the introduction of the prescription checking system (from September, 2016 to August, 2017). Although there were no changed prescriptions based on the laboratory data before using prescriptions with laboratory data, 6.6% of changed prescriptions were based on laboratory data after using prescriptions with laboratory data. In addition, the changed prescription ratio based on laboratory data significantly increased after the introduction of the prescription checking system compared with that after using prescriptions with laboratory data (8.9% versus 6.6%, P = 0.015). In conclusion, using prescriptions with laboratory data and the prescription checking system associated with laboratory data were useful for checking prescriptions effectively in order to avoid adverse drug reactions.

著者

石川 愛子 宇田 篤史 矢野 育子 冨田 猛 阪上 倫行 野崎 晃 西岡 達也 久米 学 槇本 博雄 濱口 常男 岩川 精吾 北河 修治 平井 みどり

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.44, no.4, pp.157-164, 2018-04-10 (Released:2019-04-10)

参考文献数

9

被引用文献数

3 3

---

Kobe University Hospital created a simplified 14-item protocol for resolving out-of-hospital prescription queries. The protocol was implemented in September 2016 in nine community pharmacies. If prescriptions were changed as per the new protocol or via typical query procedures, we asked community pharmacies to fax the changed prescriptions, and the hospital pharmacists, rather than medical doctors, modified the prescription history. To evaluate the effects of this simplified protocol, we examined the number of changed outpatient prescriptions and administered questionnaire surveys to community pharmacists and hospital-based medical doctors. The ratio of changed to total outpatient prescriptions decreased in January 2017 (4.1%) compared with those in September 2016 (6.4%). Ultimately, more than half of all outpatient prescriptions were changed by the protocol. Drug brand name changes accounted for 52% of the total changes during both September 2016 and January 2017, but the proportion of residual medicine adjustment increased from 12% in September 2016 to 26% in January 2017. Due to the questionnaire survey, 33% of surveyed medical doctors indicated that they knew or had heard of the protocol, and 54% responded that the protocol decreased the burden of addressing outpatient prescription queries. The community pharmacies reported that the burden of clarifying outpatient prescription queries decreased. In conclusion, implementation of the simplified protocol for outpatient prescription queries improved medical efficiency and may help promote cooperative streamlining of community patient pharmaceutical care services.

著者

面谷 幸子 池嶋 俊貴 柴野 雅仁 勝井 保弘 初田 泰敏 向井 淳治 畑中 裕子 菊内 章夫 関 源一 名徳 倫明

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.46, no.9, pp.522-530, 2020-09-10 (Released:2021-09-10)

参考文献数

13

被引用文献数

1

---

Several hospitalized patients have a history of medication use; consequently, there are numerous reports on the importance of pharmacists managing their own medications. Conversely, there is a lack of information about the status of patients’ medication adherence. Therefore, we collected data on medicines brought to hospital by inpatients and investigated their medication compliance status. The medication compliance status of patients visiting the Kokuho Chuo Hospital from April 2017 to March 2018 was investigated using the identification sheets of medicines brought by these patients and patients’ medical records. The number of differentiations of medicines brought to the hospital by inpatients was 1,080, and the details of 889 medicines were used in this study. The average number of medicines brought per patient was 5.6 ± 3.5, with elderly patients bringing more medicines and exhibiting a low medication compliance. Compliance with antibiotics, chemotherapeutics, and oncology drugs was good, whereas that of vitamins, peripheral nervous system agents, and drugs for treating sensory organ issues was poor. The cost of medication per patient among non-adherent patients was approximately 3,836 ± 11,078 yen, amounting to a total cost of 3,409,914 yen. The medication compliance status inferred from this study was worse among elderly patients as well as for medicines used to treat chronic diseases. Pharmacists can provide appropriate drug treatments and contribute toward reducing healthcare costs by increasing awareness regarding the family pharmacist system and improving cooperation between community pharmacies and hospitals to improve polypharmacy and medication adherence.

著者

豕瀬 諒 細見 光一 朴 ピナウル 藤本 麻依 髙田 充隆

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.40, no.10, pp.586-594, 2014-10-10 (Released:2015-10-10)

参考文献数

36

被引用文献数

4 3

---

To examine the association between biologics for rheumatoid arthritis and serious infections (hepatitis B, hepatitis C, tuberculosis, pneumonia and sepsis), we analyzed the US Food and Drug Administration Adverse Event Reporting System (FAERS) and the Japanese Adverse Drug Event Report database (JADER) of Pharmaceuticals and Medical Devices Agency (PMDA). The reporting odds ratio was calculated and used to detect spontaneous report signals, with detection defined as a lower limit >1 in a 95% confidence interval. In addition, time to onset and age at onset of tuberculosis were investigated. Drug-reaction pairs were identified in both FAERS (n = 29,017,485) and JADER (n = 2,079,653). In both databases, significant associations were observed between biologics and infections (hepatitis B, tuberculosis, pneumonia and sepsis). JADER data revealed a significant association of etanercept with hepatitis C. In FAERS, the majority of tuberculosis events, associated with all drugs, were observed within 1 month of administration, whereas most tuberculosis infections associated with biologics were observed during the 5 months following administration. In JADER, most cases of tuberculosis associated with all drugs and with biologics, respectively, were observed during the 2 months after administration. In conclusion, hepatitis C associated with etanercept treatment should be closely monitored in clinical practice. In addition, tuberculosis associated with biologics should be carefully monitored for 5 months following drug administration. Further studies are needed to confirm these findings.

著者

下村 斉 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.42, no.12, pp.781-794, 2016-12-10 (Released:2017-12-10)

参考文献数

53

---

The incidence of pulmonary Mycobacterium avium complex (MAC) disease is increasing worldwide. Currently, clarithromycin is the key drug for treatment of pulmonary MAC disease, and multidrug therapy with rifampicin and ethambutol is recommended. However, the efficacy of this therapy is reported to be approximately 60-80%. Therefore, this disease is often difficult to treat, and there are some problems concerning this form of chemotherapy. Firstly, rifampicin decreases the serum clarithromycin concentration owing to CYP3A4-related interactions. Although this therapy needs to be administered for more than one year, to our knowledge, no study has investigated the long-term relationship between serum clarithromycin and rifampicin concentrations and CYP3A4 activity, together with treatment efficacy. Secondly, an alternative treatment to the recommended therapy of clarithromycin, rifampicin, and ethambutol has not been established. Therefore, fluoroquinolones are often used when the clinical efficacy of the recommended regimen is insufficient. However, very few previous studies have investigated the clinical efficacy of the combination of clarithromycin and fluoroquinolones, especially levofloxacin.Our recent study demonstrated that serum clarithromycin concentrations in patients with pulmonary MAC disease were continuously low because of rifampicin-mediated CYP3A4 induction, which may be responsible for the unsatisfactory clinical outcomes observed. We also investigated the clinical outcomes achieved with the currently recommended dose of clarithromycin and levofloxacin, and suggested the possibility that combined administration of clarithromycin and levofloxacin did not improve clinical outcomes for the treatment of pulmonary MAC disease. In this mini-review, we summarize the findings of our clinical studies concerning chemotherapy for pulmonary MAC disease.

著者

寺田 真紀子 北澤 英徳 川上 純一 足立 伊佐雄

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.28, no.5, pp.425-434, 2002-10-10 (Released:2011-03-04)

参考文献数

82

被引用文献数

14 16

---

In Japan, traditional herbal medicines (kampo medicines) have been widely used for various diseases as relatively safer drugs than Western medicines. However, serious adverse-events such as interstitial pneumonia (IP) and liver dysfunction (LD) have recently been reported. In this study, IP and LD associated with Kampo medicines were reviewed pharmacoepidemiologically to establish an effective monitoring protocol and appropriate treatment schedules while also elucidating the possible ingredients for IP and LD. Medline, JICST and J-Medicine databases were searched for IP and LD induced by Kampo medicines published in 1984-2000. Thirty-five cases of IP including 8 mortal cases and 28 cases of LD have been reported. As initial symptoms, 60-80% of IP patients developed dyspnea, fever and cough. On the other hand, the initial symptoms for LD patients were not characterized. Stopping the medications improved the symptoms in 29% of IP and 54% of LD patients. A total of 72 % of IP and 7 % of LD patients required corticosteroid treatment. Scutellariae radix was contained in Kampo medicines for 94% of IP patients and 89% of LD patients. A challenge test was positive in 9 cases of IP and 10 cases of LD. Scutellariae radix was contained in all positive Kampo medicines. Our review suggested that Scutellariae radix was a possible ingredient responsible for IP and LD. Monitoring the initial symptoms and immediately stopping medications were important steps for avoiding serious adverse-events associated with Kampo medicines.

著者

味澤 香苗 鈴木 学 林 由依 甲斐 絢子 小林 篤史 小原 道子 生木 庸寛 國府田 真綾 金地 夏実 林 秀樹 棚瀬 友啓 土屋 照雄 杉山 正

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.44, no.12, pp.599-606, 2018-12-10 (Released:2019-12-10)

参考文献数

8

被引用文献数

6

---

Focusing on the Pharmaceutical Intervention Records (PIR) project conducted in collaboration with the Gifu Pharmaceutical Association and Gifu Pharmaceutical University, this study analyzed characteristics and economic effects of the audit of dispensing fees for the prevention of duplications or interactions of prescription drugs by pharmacists. The pharmacists registered audit data of 1,105 prescriptions into the PIR database in 2017. For the analysis, we divided 1,105 prescriptions into those that incurred dispensing fees for the prevention of duplications or interactions of prescription drugs (the subject group) and a control group comprising other prescriptions. The reduction in drug cost per prescription was 1,689 yen in the subject group, which was significantly higher than the reduction of 563 yen in the control group. In the subject group, pharmacists tend to use a medicine notebook for identifying duplicate administrations or drug interactions. There is a high ratio of cancellation of drugs as a result of such inquiries. This is considered a factor in the reduction of the cost of drugs. The reduction per prescription in the subject group is higher than the medical fees for the prevention of duplications or interactions of prescription drugs, and it can be evaluated that activities related to preventing duplications and interactions of prescription drugs contribute to medical economy.

著者

百 賢二 米澤 淳 岩本 卓也 大野 能之 木村 丈司 樋坂 章博 伊藤 清美

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.44, no.11, pp.559-567, 2018-11-10 (Released:2019-11-10)

参考文献数

31

---

The first academic subcommittee of the Japanese Society of Pharmaceutical Health Care and Sciences has a plan to create a guide on how to manage drug interactions in clinical settings. This review describes the information that forms the basis of the guide. As evidence for drug interactions with various mechanisms has not been clarified for all combinations, each case needs to be managed based on knowledge of clinical pharmacology regarding drug interactions. This article, part (3), shows the examples of both experimental and surveillance studies on drug interactions and also summarizes the points that require consideration when conducting surveillance studies.The focus on drug interactions based on polypharmacy is increasing given that the number of elderly people continues to increase in Japan. Pharmacists are expected to contribute to the proper use of drugs through the assessment and performance of wet and dry studies.

著者

窪田 幸恵 斉藤 和幸 小野 俊介 児玉 庸夫

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.43, no.6, pp.287-296, 2017-06-10 (Released:2018-06-10)

参考文献数

11

---

In an effort to promote self-medication in Japan, drugs switched from prescription to over-the-counter (OTC) have received a lot of attention. We conducted a survey of community pharmacists to investigate views on Rx (Prescription) -to-OTC switched drugs, aiming at the enhancement of self-medication and proposals to the Regulatory Authorities. A total of 336 respondents completed the survey. About two-thirds of respondents (65.2%) regarded the expansion of Rx-to-OTC drugs as necessary. The percentage of pharmacists who responded that Rx-to-OTC expansion was necessary at pharmacies for prescription and OTC drugs (73.2%) was significantly higher than those at pharmacies for prescription drugs (51.2%) (P < 0.001). The most common reason for Rx-to-OTC expansion being necessary was “it has a certain level of effect on reducing healthcare costs”. On the other hand, the most common reason against Rx-to-OTC expansion was “it causes safety issues for consumers”. The number of candidates for Rx-to-OTC recommended by pharmacists in favor of Rx-to-OTC expansion was 43 with 14 therapeutic areas excluding 5 drugs accepted as Rx-to-OTC switched drugs by the Ministry of Health, Labour and Welfare. Six out of 43 candidate drugs are considered to meet the requirements for Rx-to-OTC drugs. We revealed some differences in pharmacists' views on Rx-to-OTC switched drugs depending on the pharmacy category. To promote self-medication, constructing a mechanism to collect opinions of community pharmacists providing OTC drugs is required. Further research in other areas and pharmacies of different categories to confirm generalizability should be done for making a proposal to the Regulatory Authorities.