著者
小池 麻由 大津 史子 榊原 仁作 後藤 伸之
出版者
Japanese Society of Drug Informatics
雑誌
医薬品情報学 (ISSN:13451464)
巻号頁・発行日
vol.14, no.4, pp.134-143, 2013-02-28 (Released:2013-03-06)
参考文献数
20
被引用文献数
6

Objective: Recently, use of health foods and supplements, as well as the amount of information available about them, has been steadily increasing.  Therefore, a noticeable increase in adverse drug reactions caused by health foods and supplements has also been seen.  The purpose of this study was to clarify the current status and backgrounds of patients with health food- or supplement-related adverse health effects.Methods: We selected the cases of health food- or supplement-related adverse health effects from the Case Reports of Adverse Drug Reactions and Poisoning Information System (CARPIS) database, which contains over 57,000 case reports of adverse drug reactions.  We investigated the background, suspected products and adverse events in each case and conducted univariate logistic regression analysis to determine significance.Results: We obtained a total of 327 cases consisting of 103 causative products.  Women comprised 66% of study subjects and had a significant association with dietary supplements.  Patients with a history of liver disease had a significant association with liver damage caused by “Ukon,” a drink made from turmeric root and sold as an anti-hangover remedy in Japan.Conclusion: The causative products had several unique features.  This information should be utilized to prevent health food- and supplement-related adverse health effects in the future.
著者
中川 直人 村井 ユリ子 小原 拓 大原 宏司 栗田 幸代 Lai Leanne
出版者
Japanese Society of Drug Informatics
雑誌
医薬品情報学 (ISSN:13451464)
巻号頁・発行日
vol.19, no.4, pp.180-187, 2018 (Released:2018-03-21)
参考文献数
9
被引用文献数
1

Objective: The clinical literature review is an important and required components in most of the US pharmacy school curriculum.  On the other hand, in Japan, pharmacy students usually read basic literature when research assignments are given.  However, in Japan, one is rarely taught how to critically read clinical literature in class.  Therefore, for the purpose of examining whether or not lectures regarding how to critically read clinical literature will affect collecting new drug information in pharmacy practice, we examined a survey which we circulated in both countries.  The survey asks pharmacists about reading clinical literature.Methods: One thousand nine hundred and ninety-seven pharmacists in Miyagi in Japan were given questionnaires by mail and 18,744 pharmacists in Florida in the US were given the URL of a web questionnaire by email.Results: Response rates in Miyagi and Florida were 30.3% and 0.91%, respectively.  Since the response in Florida was so small, statistical analysis was not performed.  Regarding the question of “Do you HABITUALLY read clinical literature ?,” “Yes” in Miyagi and Florida was 14.7% and 71.9%, respectively.  Regarding the question of “To what extent did you learn how to critically read clinical literature when you were a student-pharmacist ? ” (1: Not at all, 7: Yes), medians in Miyagi and Florida were “1” and “5,” respectively.  Regarding the question of “To what extent do you apply the information you obtain from clinical literature to your daily responsibilities ? ” (1: Not at all, 7: Yes), medians in Miyagi and Florida were “2” and “5,” respectively.Conclusions: We conclude that Japanese pharmacists in clinical practice do not sufficiently utilize drug information from new clinical literature because pharmacy education in Japan did not, until very recently at least, teach how to critically read clinical literature in class.
著者
豊田 紗和子 吉村 祐奈 矢野 玲子 青柳 裕 大津 史子 後藤 伸之
出版者
一般社団法人 日本医薬品情報学会
雑誌
医薬品情報学 (ISSN:13451464)
巻号頁・発行日
vol.21, no.2, pp.70-78, 2019-08-31 (Released:2019-10-10)
参考文献数
31

Objective: To clarify the background difference between drug-induced photosensitivity and ultraviolet-visible absorption spectrum or structure and to construct useful information for prevention and prediction of drug-induced photosensitivity. Methods: We investigated whether, for 457 drugs for which the ultraviolet-visible absorption spectrum is listed in the Japanese Pharmacopoeia, there were absorption maxima in the UVA (320 nm or more and less than 400 nm), UVB (280 nm or more and less than 320 nm), or UVA and UVB (280 nm or more and less than 400 nm). Structure was investigated for the existence of “conjugated”, carbonyl, sulfone, nitro and fluorine. The case drug group was taken to be those drugs for which photosensitivity was listed as a side effect on the medical drug package insert. Using statistical software, SPSS statistics ® 24 (IBM), we performed univariate logistic regression analysis, and multivariate logistic regression analysis with a stepwise increment method (likelihood ratio) combining items with p<0.2, and calculated the odds ratio (hereinafter: aOR). The significance level was taken as 0.05.Results: There were 85 drugs in the case drug group, and 372 drugs in the control drug group. As a result of multiple logistic regression analysis, in Model 1, we placed sulfone (aOR: 4.55, 95% C.I.: 2.22-9.35), fluorine (aOR: 3.66, 95% C.I.: 1.82-7.39) and nitro (aOR: 4.46, 95 % C.I.: 1.73-11.48) in this order. In Model 2, we placed sulfone (aOR: 4, 40, 95% C.I.: 2.12-9.15), fluorine (aOR: 3.81, 95% C.I.: 1.87-7.76), UVA (aOR: 2.40, 95% C.I.: 1.37-4.18) and nitro (aOR: 3.61, 95% C.I.: 1.39-9.40) in this order.Conclusion: When a drug is developed, its ultraviolet-visible absorption spectra and structure become clear, and from this information,measures can be taken which bear the potential risk of photosensitivity in mind.
著者
恩田 光子 今井 博久 春日 美香 安田 実央 下村 真美子 岡本 夏実 高田 百合菜 七海 陽子 田中 有香 荒川 行生
出版者
Japanese Society of Drug Informatics
雑誌
医薬品情報学 (ISSN:13451464)
巻号頁・発行日
vol.17, no.1, pp.21-33, 2015 (Released:2015-06-28)
参考文献数
37

Objective: To examine the effect of pharmacists’ visits to homebound patients on the elimination of unused drugs.Method: We conducted a survey with pharmacies throughout Japan that provided home-visit service, asking them questions regarding their work with up to five patients (the survey period was from January 15 through the end of February, 2013).  Main survey questions were: (1) whether they managed unused drugs since the start of their home-visit, and (2) how they managed the unused drugs.  For (2), we conducted case studies by asking the pharmacists to choose the case that impressed them most and describe the unused drugs involved, actions taken, and the results.Results: Data on 5,447 patients were collected from 1,890 pharmacies throughout Japan (collection rate: 56.9%).  Pharmacists managed unused drugs from 2,484 patients (45.6%). 1,746 patients (3,590 cases) were qualified for analysis.  In 2,332 cases (65.0%), pharmacist intervention eliminated the incidences of unused drugs.  In 782 cases (21.8%), unused drugs were discarded, while the number of drug administration days was adjusted in 2,623 cases (73.1%).  In 21 cases (0.6%), drugs were both discarded and had the number of days adjusted.  There were others for 164 cases (4.5%).  The total price of the eliminated unused drugs was approximately 6,920,000 yen (4,000 yen/person).  Illnesses that benefited most from the elimination of unused drugs were chronic respiratory failure (16,306 yen/person), and Parkinson’s disease (4,803 yen/person).Conclusion: We confirmed the economic effect of eliminating unused drugs by pharmacists’ home visits.
著者
横井 正之 田城 孝雄
出版者
Japanese Society of Drug Informatics
雑誌
医薬品情報学 (ISSN:13451464)
巻号頁・発行日
vol.19, no.4, pp.188-194, 2018-02-28 (Released:2018-03-21)
参考文献数
10

Objective: We analyzed the effects of the number of prescriptions on the number of drug stocks in community pharmacies by administering questionnaires to community pharmacies in Shiga Prefecture, Japan (N=159).Methords: We identified a significant positive correlation between drug stocks and their amount, and a significant negative correlation between inventory turnover and the concentration ratio of prescriptions issued by any medical institutions.  Therefore, this implies that the amount of drug stocks influenced value, and a lower ratio of prescriptions issued by neighboring medical institutions increased inventory turnover.  Furthermore, multi-regression analyses on the amount of drug stocks and the number of prescriptions from neighboring medical institutions and other medical institutions were performed.  The results are as follows.Results: The number of stock drugs is much less influenced by the number of the prescription of vicinity medical institutions than the other medical institutions.  On the other hands, the money amount of stock is more influenced by the number of the prescription of vicinity medical institutions than the other medical institutions.Conclusions: We thus identified the relation between the number of prescriptions from neighboring or other medical institutions and the number of drug stocks and their amount.  These findings will be made available to community pharmacies that want to prescriptions issued by not only the neighboring medical institutions but others as well.
著者
小室 雅人 折井 啓一郎 小野寺 祐加 白神 誠
出版者
一般社団法人日本医薬品情報学会
雑誌
医薬品情報学 (ISSN:13451464)
巻号頁・発行日
vol.15, no.3, pp.111-117, 2013 (Released:2013-12-27)
参考文献数
6

Objective: If product information provided by pharmaceutical manufactures is not consistent with a product assessment made by the Pharmaceuticals and Medical Devices Agency (PMDA), users may gain false perceptions about the product, which may be detrimental to patients.  An investigation was conducted to compare the contents of product information provided by pharmaceutical manufacturers and product evaluation reports prepared by PMDA to identify any discrepancies between data assessment in the two documents.Methods: Descriptions in “Product Characteristics” and “Clinical Studies” of product information summaries were compared with product evaluation reports prepared by PMDA.  Inquiries were addressed to manufacturers if any questions arose.Results: The investigation was conducted on 66 new active ingredients approved in 2009 to 2010.  As 14 questions arose with 12 ingredients, inquiries were addressed to manufacturers, all of whom offered a response.  As a result, four questions were resolved for two ingredients.  However, for the remaining products, it was revealed that the manufacturers described in the product information summaries what they claimed at the time of submission even though their claims were not accepted by PMDA.Conclusion: It was considered that the pharmaceutical manufacturers possibly did not comprehend the contents of the PMDA’s evaluation reports.  It was suggested that the industry as a whole should examine the issue.  As discrepancies were observed even in product information summaries, which are viewed by a relatively large number of people, it was assumed that more issues may be found in promotional materials provided exclusively to healthcare professionals.
著者
丹羽 浩子 田辺 公一 矢野 玲子 後藤 伸之 大津 史子
出版者
一般社団法人 日本医薬品情報学会
雑誌
医薬品情報学 (ISSN:13451464)
巻号頁・発行日
vol.20, no.3, pp.145-155, 2018-11-30 (Released:2018-12-08)
参考文献数
26

Objective:In this study,we explored adverse reactions and patient background and performed a case/non-case study on a database of adverse reaction case reports in order aid the prevention of non-prescription drug abuse.Study Design:We conducted a case/non-case study on a database of adverse reaction case reports.Methods:We studied case reports of adverse reactions and addiction in Japan and extracted adverse reaction cases associated with taking antipyretic analgesics,antitussive drugs,antitussive expectorant drugs,hypnotic and sedative drugs,anti-anxiety drugs,and purgative drugs. We divided the extracted cases into an abuse case group (adverse reactions associated with non-prescription drug abuse,and divided its intended purpose or the purpose of abuse at the initial dose)and non-case group(other adverse reactions). We performed univariate logistic regression analysis on each item of investigation in the abuse case group and non-case group and calculated the odds ratio,p-value,and 95%confidence interval.Results:There were many abuse case reports of women 20-40 years old in the antipyretic analgesics abuse case group and many of them had liver/biliary lesions and chronic urological impairment. The most common reason reported for taking the initial dose of each drug was for its intended purpose.Discussion:It is important for pharmacists at community pharmacies and drugstores to be able to recognize the characteristics of patients who might be at risk of abuse and the adverse reactions and patient backgrounds elucidated in this study could be helpful in identifying them.
著者
長南 謙一 大和 幹枝 高木 彰紀 土肥 弘久
出版者
一般社団法人 日本医薬品情報学会
雑誌
医薬品情報学 (ISSN:13451464)
巻号頁・発行日
vol.22, no.1, pp.1-6, 2020-05-29 (Released:2020-06-13)
参考文献数
21

Objective: The Relief System for Sufferers from Adverse Drug Reactions was created for the purpose of remedying issues such as medical expenses for people who experience an adverse drug reaction despite the proper use of a medicine.Methods: We used “decision data on adverse drug reaction payments” released by the Pharmaceuticals and Medical Devices Agency to investigate the payment of all medical supplies for adverse drug reactions associated with the HPV vaccine over the 7-year period between 2011 and 2017.Results: The HPV vaccine had a lower rate of supply than all other medical supplies. Medical costs and medical allowance accounted for the majority of supplies for the HPV vaccine. The most common response was “A causal linkage between adverse reactions and the HPV vaccine cannot be confirmed”, followed by “It is not recognized as medical care requiring hospitalization”.Conclusion: Many patients with an adverse drug reaction received no medical supplies, mainly for the reason of “undecidable”. With regard to these patients, it may be necessary to carry out a survey so that they can be judged rather than classifying them as ‘undecidable’.
著者
鹿村 恵明 田中 愛佳 根岸 健一 下平 秀夫 若林 進 塚原 俊夫 野村 香織 出石 啓治 宮崎 長一郎 望月 眞弓 上村 直樹
出版者
一般社団法人日本医薬品情報学会
雑誌
医薬品情報学 (ISSN:13451464)
巻号頁・発行日
vol.18, no.4, pp.242-250, 2016-02-28 (Released:2017-03-17)
参考文献数
18

Objective: For effective use of over-the-counter (OTC) drugs that are provided as relief supplies during a disaster, we aimed to develop a list of OTC drugs that can be used during a disaster.Methods: We obtained information about OTC drugs useful during a disaster by examining results of previous studies and lists of drugs used during a disaster.  We analyzed this information with the expert pharmacist of disaster support and established a rationale for our list and developed “the List of Useful OTC Drugs During a Disaster” and “the Information Card on Useful OTC Drugs During a Disaster.”Results: We developed our list of OTC drugs based on the following parameters: (1) while people with severe disorders (e.g. renal failure) are treated by medical teams, those with minor physical conditions are treated using OTC drugs and (2) those OTC drugs that can be used as substitutes for prescription drugs were preferably selected.  The List of Useful OTC Drugs ()—During a Disaster (containing 56 items) was developed for use mainly by medical professionals.  Further, pharmacists from disaster-relief medical teams may not always be available in disaster-stricken areas; therefore, the Information Card on Useful OTC Drugs During a Disaster was developed to enable disaster victims to independently make a certain level of decision.  The information card contained pictograms to call the attention of the disaster victims.Conclusion: Our results can provide a common tool for drug suppliers, medical professionals engaging in relief works in disaster-stricken areas, and disaster victims.
著者
竹下 治範 井上 知美 髙瀬 尚武 波多江 崇 室井 延之 濵口 常男
出版者
Japanese Society of Drug Informatics
雑誌
医薬品情報学 (ISSN:13451464)
巻号頁・発行日
vol.18, no.4, pp.270-276, 2017-02-28 (Released:2017-03-17)
参考文献数
10

Objective: Finger-tip unit (FTU) has been used in Western countries to apply a specific amount of steroid ointment available in tube form.  Although prescription ointments for treating skin disorders are available in Japan, there are no indications for patients regarding the amount to be used.  Therefore, we investigated the factual assessment of patient compliance instructions on using the ointments given by pharmacists and conducted a comparative test on the amount of ointment in 1 FTU using commercially available ointment tube products.Methods: We conducted a questionnaire survey for 21 hospital pharmacists on patient compliance instructions for ointments.  Using six types of ointments, we measured the aperture area of ointment tube, weight of 1 FTU and squeezing number of tube.Results: Fewer than 50% of pharmacists explained the application methods and amounts for one-time use when they provided patient compliance instructions.  There were many patients who used an ointment inadequately.  The most were problems about the quantity of application.  Wide variations were found among the amount of ointment in 1 FTU weight and number of available uses.Conclusion: The survey results demonstrated that the methods used to apply the ointments are items that must also be emphasized by pharmacists when providing patients compliance instructions.  Furthermore, the patient compliance instructions should include the amount of ointment in 1 FTU and number of available uses within pharmaceutical products.
著者
佐藤 弘康 晴山 知拓 大井 菜美子 谷口 雄人 石田 陽美 八幡 弘子 橋本 義宏 小森 均
出版者
Japanese Society of Drug Informatics
雑誌
医薬品情報学 (ISSN:13451464)
巻号頁・発行日
vol.16, no.2, pp.63-69, 2014 (Released:2014-09-06)
参考文献数
12
被引用文献数
2

Objective: Taking the wrong medicine or medication error is a serious concern to patient safety.  The aim of this study was to statistically survey the relation between the placement of drugs on medicine shelf and the occurrence of error in taking a medicine.Methods: The study comprised 2 groups.  The incident group contained 43 cases that were erroneously taken in the Obihiro Kosei General Hospital.  The control group contained 43 drug pairs matched by the similarity index of the drug names from among the drugs used in the hospital at random.  The similarity index of drug names was based on 10 quantitative indicators.  The distance of medicine shelf arrangement was represented by three variables: the horizontal distance, the vertical distance and the distance of shelf block.  Conditional logistic regression analyses of the occurrence of medication errors were performed by evaluating the three variables of the distance factor and their interaction for error in taking a similar-sounding named drugs.Results: Conditional logistic regression analysis revealed that the vertical distance (OR: 0.64, 95%CI: 0.42-0.99) and the distance of the shelf block (OR: 0.74, 95%CI: 0.57-0.97) were significant risk-reduction factors of medication errors.  Four variables were extracted as the most suitable logistic regression model in terms of the interaction between them.  As the interaction between 3 variables (the horizontal distance, the vertical distance and the distance of shelf block) was significant (OR: 0.93, 95%CI: 0.86-0.99), they may be considered as synergistic risk-reduction factors.  Moreover, the horizontal distance was found to be a risk-enhancement factor (OR: 1.52, 95%CI: 0.93-2.48).Discussion: In order to reduce the risk of medication errors due to similar-sounding drug names, placement of drug on the medicine shelf should take into consideration the three coordinates of the distance factor.
著者
舘 知也 野口 義紘 寺町 ひとみ
出版者
Japanese Society of Drug Informatics
雑誌
医薬品情報学 (ISSN:13451464)
巻号頁・発行日
vol.20, no.1, pp.1-11, 2018 (Released:2018-06-16)
参考文献数
68

Objective: A medication notebook is developed in order to unitedly manage medication information of patients and is used by writing medication information such as history of ethical drugs, over-the-counter drugs and health foods, anamnesis, history of adverse events and allergy.  Adverse events, interaction and duplication of drugs can be prevented by showing a medication notebook to doctors and pharmacists.Data Sources·Study Selection·Data Extraction: In this article, we reviewed literatures regarding preceding studies on the utilization of medication notebooks comprehensively.Results·Conclusion: In our review, we could comprehend literature on medication notebooks systematically and could summarize a lot of evidences that confirm the usefulness of medication notebooks.  We need to produce further evidences on medication notebooks to spread medication notebooks.
著者
奥村 康子 小田 雅子 齊藤 浩司
出版者
一般社団法人日本医薬品情報学会
雑誌
医薬品情報学 (ISSN:13451464)
巻号頁・発行日
vol.17, no.1, pp.34-38, 2015 (Released:2015-06-28)
参考文献数
9

Objective: Consultation contents from medical consumers can become a useful information for medical workers.  However, report which investigated about them is limited.  In this study, we investigated the question contents from medical consumers with telephone.Methods: Nineteen hundred records on the consultation from medical consumers with telephone from 2007 to 2011 were subject to this study.  Using appropriate keywords and check the records, corresponding cases were extracted.Results: Resources of drug information which medical consumers used had various one such as the Internet, television, books, and newspapers.  However the medical consumers did not necessarily understand drug information correctly from the Internet and books.  This means that support by pharmacists was necessary in those cases.Conclusion: We think that information sharing in the medical consumers and medical workers based on a good relationship is important for proper use of drugs.
著者
大谷 壽一 藤井 萌未 今岡 鮎子 望月 眞弓 山浦 克典 秋好 健志
出版者
一般社団法人 日本医薬品情報学会
雑誌
医薬品情報学 (ISSN:13451464)
巻号頁・発行日
vol.22, no.1, pp.30-34, 2020-05-29 (Released:2020-06-13)
参考文献数
5

Background: Although transferring drugs to a third party, even in a personal capacity, is illegal in Japan, many drug transactions are carried out via internet auction sites. Pharmacy consumers might not be aware of the illegality of transferring drugs to others due to various factors. To clarify pharmacy consumers’ awareness of this issue and its covariates, we carried out a questionnaire survey.Methods: A self-completed questionnaire, consisting of yes/no and multiple-choice questions, was used. The adult patients who visited Keio University Pharmacy were asked to fill out the questionnaire.Results and Discussion: One hundred and fifty-one response sheets were effectively collected from 173 responders. The subjects’awareness of the illegality of transferring drugs was significantly affected by the formulation (oral vs. patches) and pharmacological category of the drug, as well as the source of the drug (prescribed vs. over the counter). Patient education about the illegality of personally transferring drugs, especially patches, might be required to avoid illegal drug transfers, including via the internet.
著者
馬場 香菜子 小原 依里 飯原 なおみ
出版者
一般社団法人 日本医薬品情報学会
雑誌
医薬品情報学 (ISSN:13451464)
巻号頁・発行日
vol.22, no.1, pp.35-43, 2020-05-29 (Released:2020-06-13)
参考文献数
29

Benzodiazepine receptor agonists (BZs) are medications to be used with caution, not only for long-time users, but also for first-time users. This study aimed to compare the use of BZs or central nervous system (CNS) agents in first-time BZs users (FU) and continuing BZs users (CU). Using a large health insurance claims database in Japan, BZs users aged ≥40 years in 2013 who were opioid non-users without hospitalization were classified into FU or CU, by use of BZs in the first half-year. BZs or CNS agent use at the index date (the first date BZs were dispensed in the latter year) was investigated as follows: (1) proportion of patients with prescriptions of BZs for use as needed (BZs-AN), (2) daily number of BZs or CNS agents, and (3) daily standardized dose of BZs or CNS agents. More individuals in the FU group (3,162/16,576; 19%) than in the CU group (7,627/46,088; 17%) received BZs-AN (p<0.001); 87% of the FU group vs 62% of the CU group used single BZs (p<0.001), and 53% vs 24% used less than 5 mg/day of equivalent diazepam (p<0.001). A similar trend was found for CNS agents. Numbers or doses of BZs or CNS agents decreased with increasing age in both groups. However, some first-time users aged 70-74years started with ≥2 types of BZs or ≥10 mg/day of equivalent diazepam. Overall, BZs for outpatients without opioids were started carefully, but a prescription review was necessary for some patients, requiring more effort from healthcare providers.
著者
山本 晃之 上村 直樹
出版者
一般社団法人日本医薬品情報学会
雑誌
医薬品情報学 (ISSN:13451464)
巻号頁・発行日
vol.18, no.4, pp.295-300, 2017 (Released:2017-03-17)
参考文献数
10

Objective: The dispensing fee revision of April in 2016 made a review of the assessment of inquiries about prescriptions.  The requirement was added by articles that seemed to be pharmaceutically necessary, showing an increase of responsibility for pharmacists.  Based on this, we performed a discussion while collecting the cases of inquiries about prescriptions.Method: Among the inquiries about prescriptions performed at Jinjo Pharmacy for 4 months starting from April in 2016, we selected 83 cases where a prescription was changed by the pharmacist’s recommendation, based on pharmaceutical information such as drug duplication or drug interaction and confirmation of leftover medicine.  Then, we compared them with the study of inquiries about prescriptions performed by the Japan Pharmaceutical Association in 2015.Result/Consideration: Inquiries about dose were the leading content, followed by those about duplication with other drugs of same indications and appropriateness of dose considering the adjustment of number of days due to residual drug, which showed the importance of medicinal history and prescription records.  It is considered necessary to renew the contents of the prescription record properly, based on the information acquired, while at the same time changing the pharmaceutical history based on those records.  It is thought that an inquiry about prescriptions will be performed appropriately by making a judgment based on such information. In order to do that, updated knowledge about medicine and updated information about drugs is necessary.  In comparison of the two studies, both showed that the drug information on “safety” and “dose and dose regimen” accounted for a large part of inquiries.  Further consideration on them will be necessary.
著者
中島 誠 中木原 由佳 高橋 武士 野間口 寛 寺師 守彦 林 秀樹 杉山 正
出版者
一般社団法人日本医薬品情報学会
雑誌
医薬品情報学 (ISSN:13451464)
巻号頁・発行日
vol.18, no.1, pp.13-21, 2016 (Released:2016-06-13)
参考文献数
19

Objective: We have used therapeutic drug monitoring (TDM) analysis software to set the initial dose of vancomycin in our hospital.  In contrast, the TDM guideline, in which the initial dose of vancomycin per body weight was set, was published in 2012.  We looked forward with utilizing the TDM guideline in the clinical setting, after which we conducted multiple surveys to determine the important points of the TDM guideline.Methods: We surveyed patients treated with vancomycin, in whom the initial dose was set using the TDM analysis software and the concordance rate between the vancomycin dose set with the software and that set with the TDM guideline.Results: The concordance rate of vancomycin dose was 42.1%.  The mean age of the high-dose group (vancomycin dose higher than that recommended by the TDM guideline), was younger than that of the recommended-dose group.  Additionally, the mean body weight of the high-dose group was significantly lower than that of the recommended-dose group.  The corrected creatinine clearance of the low-dose group was significantly lower than that of the recommended-dose group.Conclusion: Our results suggest that when the initial dose is set after referring the TDM guideline in patients who are not very high age, and having low body weight and decreased renal function, the dose may differ from the dose set by using TDM analysis software.  In addition, since the recommended dose per body weight is a range and not a single value, setting the dose appropriate to target trough concentration is necessary.
著者
竹馬 章悟 小川 竜一 越前 宏俊
出版者
Japanese Society of Drug Informatics
雑誌
医薬品情報学 (ISSN:13451464)
巻号頁・発行日
vol.17, no.4, pp.175-184, 2016 (Released:2016-03-19)
参考文献数
72

Objective: To evaluate the validity of dosage adjustment of renally eliminated drugs using Giusti and Hayton method in patients with renal dysfunction by reviewing the pharmacokinetic data of the drugs.Design: A systematic literature review.Methods: Drugs with the following characteristics: ≥70% of the drug excreted in urine is the unchanged form and ≥20% of the drug in plasma is the unbound drug, were retrieved from Goodman and Gilman’s the Pharmacological Basis of Therapeutics, 12th edition.  For the drugs identified, the area under the concentration-time curves (AUC) obtained from pharmacokinetic studies in healthy subjects and patients with renal dysfunction were extracted from package inserts, interview forms, summary basis of approval, and by systematic review of the MEDLINE database.  Pharmacokinetic studies in children, patients with end-stage renal disease, patients on hemodialysis, and kidney transplanted patients were excluded from this review.  The observed AUC ratio (AUCRobserved) of a drug was calculated by dividing mean AUC of patients by that of healthy subjects, and stratified by creatinine clearance (CLcr) into three categories: 50 to 79 mL/min, 30 to 49 mL/min, and 10 to 29 mL/min.  Theoretical AUC ratios (AUCRpredicted) of drugs for the respective CLcr categories were calculated using Giusti and Hayton method.Results: Twenty-six drugs met our study criteria, and 43 data sets were obtained from the data sources.  The AUCRobserved deviated from the AUCRpredicted by more than ±50% in 3 of 35 (9%) data sets for CLcr 50 to 79 mL/min, 4 of 39 (10%) data sets for CLcr 30 to 49 mL/min, and 7 of 29 (24%) data sets for CLcr 10 to 29 mL/min.Conclusion: Since AUCRpredicted calculated by Giusti and Hayton method erratically over- or under-estimates the maintenance doses in patients with reduced renal function, the use of AUCRobserved is preferred for dose adjustment in these patients.
著者
鈴木 信也 川口 崇 猪狩 賢蔵 草野 淳一 安藤 栄輝
出版者
Japanese Society of Drug Informatics
雑誌
医薬品情報学 (ISSN:13451464)
巻号頁・発行日
vol.18, no.4, pp.235-241, 2017 (Released:2017-03-17)
参考文献数
24

Objective: Celecoxib has been reported to enhance the action of warfarin by inhibiting CYP2C9, its major hepatic drug-metabolizing enzyme, but sufficient information about the mechanism has not been obtained, especially in Japan.Methods: A study was conducted to investigate the prothrombin time international normalized ratio (PT-INR) and the warfarin sensitivity index (WSI) before and after concurrent administration of celecoxib, as well as the Drug Interaction Probability Scale (DIPS) scores to determine causality with drug interactions, in patients commencing concurrent therapy with celecoxib and warfarin at Kanagawa Prefectural Keiyukai Keiyu Hospital during the 4-year period from October 2011 to September 2015.Results: Analysis of 18 patients showed that the PT-INR increased significantly from 1.53±0.43 before concurrent therapy to 2.18±1.01 after concurrent therapy (p=0.0101).  The WSI also increased significantly from 0.76±0.50 before concurrent therapy to 1.01±0.65 after concurrent therapy (p=0.0044).  According to the DIPS scores, the causal relation was not rated as “Highly Probable” in any of the patients, while it was considered to be “Probable” in 3 patients, “Possible” in 10 patients, and “Doubtful” in 5 patients.Conclusion: The findings of this study suggested that when celecoxib treatment is initiated in patients who are already taking warfarin, attention must be paid to changes of coagulation profile, especially in elderly patients.