Glucagon-like peptide-1 (GLP-1) is an incretin, a general term for gastrointestinal hormones that enhance insulin secretion in a glucose concentration-dependent manner. GLP-1 has been shown to improve blood glucose levels in patients with diabetes and promote extrapancreatic effects such as weight loss and lipid level improvements. The GLP-1 receptor agonists (GLP-1RAs) liraglutide and semaglutide have already been approved for weight loss treatment in addition to their use in treating type 2 diabetes in the United States and Europe, with specific conditions for obesity indications. In Japan, semaglutide has been approved as a treatment for obesity; however, it has not yet been marketed. Therefore, there have been reports on the unrestricted (off-label) use of GLP-1RAs for cosmetic and weight-loss purposes, which is considered problematic. As the use of GLP-1RAs is expected to increase in the future and is not limited to treating type 2 diabetes, this study investigated the use of GLP-1RAs and confirmed their safety in cell cultures exposed to GLP-1RAs. The culture of gastrointestinal epithelial cells using the three components of GLP-1RAs (liraglutide, semaglutide, and dulaglutide), which are prescribed in large quantities, suggested that exposure to high doses for 24 h did not affect cell viability or total cell protein content compared to controls, suggesting that the drug has not injurious after short-term exposure to the gastrointestinal epithelium.

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The incidence of diabetes mellitus increases with age and is expected to increase in the aging population of Japan. Although numerous drugs, ranging from oral to injectable formulations, have been developed for the treatment of diabetes, first-line medication is unavailable. Japan Diabetes Society states that blood glucose control goals should be set individually based on several factors, such as age, disease duration, complications, and risk of hypoglycemia. Drug selection should be based on the pathophysiology of each patient, considering the action and side effects of each drug. However, elderly people with diabetes are more likely that younger patients to develop side effects such as severe hypoglycemia, and care must be taken in the selection of therapeutic agents. Among the oral agents of concern for hypoglycemia are sulfonylurea (SU) drugs. Therefore, regional differences in the quantity of SU drugs prescribed were analyzed in this study, with the aim of preventing hypoglycemia and other problems. In addition, the age range of patients using SU drugs was investigated. The results showed that SU was widely used in the Kinki regions, but less so in Kyushu, indicating regional differences. In addition, approximately 60% of the patients taking SU drugs were ≥ 70 years old. Therefore, the study results suggest that the regional and age differences in the number of SU drug prescriptions should be taken into consideration when providing guidance to prevent hypoglycemia.

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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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A simple suspension method is widely used in clinical practice to administer oral medications through a feeding tube. Previously, the interview form (IF) lacked sufficient information regarding the feasibility of administering a medication using this simple suspension method. However, the December 2019 revision to the IF description guidelines allowed for the inclusion of information on the properties of disintegration or suspension and tube passage for the tubal administration of medications. In this study, the “description of information on the properties of disintegration or suspension and tube passage for the tubal administration of medications” in the IF was considered as “information on simple suspension method.” A total of 323 products using medications listed in Japan’s National Health Insurance Drug Price Standards from January to December 2020 were surveyed for their description of the simple suspension method. The following items were mentioned: (1) disintegration or suspension and tube passage properties for tubal drug administration, (2) suspension stability, (3) pH of suspension, (4) enquire individually, (5) no relevant data, and (6) not applicable. In total, 148 (45.8%) products had statements, of which 26 (8.0%) were enquire individually, 21 (6.5%) had no relevant data, 1 (0.3%) was not applicable, and 100 (31.0%）confirmed whether they could be administered using simple suspension method based on the IF. In products with information on whether they could be administered using the simple suspension method, the time required for disintegration or suspension in hot water at 55℃ and tube diameter was confirmed; however, the description of the test method and the determination of results were not standardized. In conclusion, the results suggest that obtaining appropriate information on whether drugs can be administered using simple suspension method from the IF is difficult, and that a unified standard for the description of simple suspension methods is desirable.

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