With the recent development of several new drugs in the pharmacological treatment of epilepsy, combination therapy is often implemented for patients who do not respond satisfactorily to conventional pharmacotherapy. There are few reports that have examined the effects and adverse reactions of drug concentrations in the blood of these patients, while taking into account various clinical backgrounds. In this study, we analyzed seizure remission and adverse event occurrence in terms of the concentration of various antiepileptic drugs in the blood of patients who received antiepileptic drug treatment in actual clinical settings, along with patient background. The study included outpatients at the Nara Medical Center Epilepsy Center, and data were retrospectively extracted from medical records. The target drugs were valproic acid (VPA) and 10 other drugs. The data of 734 patients were divided into a monotherapy group (hereafter, monotherapy) and a multidrug therapy group (hereafter, combination therapy), and statistically analyzed for treatment effect and occurrence of adverse events, with drug levels in the blood and each clinical background as variables. Treatment efficacy was evaluated by complete resolution of seizures (remission) and non-remission, and adverse events were surveyed during outpatient visits for the presence of 23 subjective symptoms. When evaluating the therapeutic effects of VPA, carbamazepine (CBZ), levetiracetam, and lamotrigine in monotherapy, no significant differences were found in drug blood concentrations between remitting and non-remitting patients. For all drugs, the concentrations in the blood were lower than the reference drug concentrations recommended in the guidelines in approximately 40– 50% of patients who achieved remission. Mean blood concentrations of VPA and CBZ and clonazepam were significantly higher in non-remitting patients than in remitting patients for combination therapy. Moreover, the probability of developing an adverse event was not related to blood concentration in either monotherapy or combination therapy. Furthermore, it was revealed that among non-remitting patients without adverse events in monotherapy and combination therapy, approximately 20% of patients had blood drug concentrations lower than the reference concentration range. In conclusion, in pharmacological treatment of epilepsy, starting a single drug at a low dose and gradually increasing the dose while confirming clinical efficacy is important. Furthermore, since there are a certain number of patients who do not experience adverse events and do not achieve remission, it is suggested that pharmacists may be able to suggest an increase in the dose of antiepileptic drugs while checking blood drug concentrations.

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Glucagon-like peptide-1 receptor agonists provide good glycemic control and weight loss in patients with type 2 diabetes mellitus. Because of its large molecular weight, it has low permeability in the gastrointestinal tract and is liable to enzymatic degradation in the stomach. As a result, only an injectable formulation was developed and launched into the market. In recent years, however, an oral formulation of a glucagon-like peptide-1 receptor agonist, semaglutide, was developed by utilizing absorption enhancers. Nevertheless, a strict patient adherence to medication and proper drug management is required owing to a lower absorption with food, the stability and hygroscopicity of the oral formulation. To our knowledge, there are few case reports on the effects of differences in medication and drug management on therapeutic efficacy of the oral formulation of semaglutide. In this report, we present two patients who lost clinical efficacy of the drug due to different mechanisms of medication and drug management after switching from the injectable formulation to oral formulation of the drug. The patient with reliable medication and drug management maintained blood glucose levels similar to those noted treatment with the injectable formulation and lost weight. In contrast, in the poor medication and drug management patient, blood glucose levels and body weight deteriorated to those at the beginning of diabetes treatment; this was noted after 8 months of therapy with the oral formulation. Therefore, oral formulations requiring strict medication and drug management should thoroughly be monitored by pharmacists. In addition, it was also considered necessary to select an injectable drug not solely based on the method of management but also on factors such as the convenience of weekly management to ensure treatment.

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Despite fabric softeners being a common part of daily life since 2008, reports of damage caused by the use of microencapsulation technology in fabric softeners have emerged. However, public awareness of the harm caused by the use of scented products remains limited. Thus, the present study aimed to clarify the public's awareness of the use of scented products and propose strategies for pharmacists to assist individuals in taking responsibility for maintaining a healthy living environment while utilizing their professional abilities to protect public health. To monitor the situation of fragrance damage from fragrant products, such as fabric softeners, changes in physical condition, knowledge, and countermeasures, we conducted a monitoring survey through a questionnaire. This survey was conducted among Japanese men and women registered with an internet research company, yielding 348 valid responses (valid response rate: 94.6%). Among the respondents, 21.8% reported that they ‘have’ experienced physical symptoms upon using scented products, with ‘nausea,’ ‘headache,’ and ‘sneezing/runny nose’ being the most common symptoms. Fabric softeners were the most common products thought to cause these symptoms (44.7%). After experiencing such symptoms, 26.3% of the respondents ‘began to avoid crowds.’ The most common measure for eliminating the harm caused by scented products was setting rules for their use. However, concerns were noted about the lack of public awareness of the health hazards associated with scented products and the term ‘harm caused by fragrance’, potentially leading to misunderstandings of these symptoms as personal preferences. In response to this situation, we suggested that pharmacists should provide consultations from the perspective of environmental hygiene and collaborate with companies and related organizations to educate local residents on the appropriate use of fragrances and fragrance-related harm.

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