がん悪液質は、体重減少、食欲不振、倦怠感といった患者の quality of life（QOL）を低下させる症状と強く関連し、さらに、抗がん剤への忍容性の低下やがん性疼痛などにも関与しており、予後を悪化させる因子である。また、がん悪質液の進行には、抗がん剤や放射線療法の副作用である味覚障害や口内炎などが関与していることが考えられている。なかでも、味覚障害は、抗がん剤の使用患者の半数以上で生じる副作用であるが、致命的な副作用ではないことや治療成績に直接的な影響を及さないことなどから重要視されておらず、依然、有効な治療･対処法は確立されていない。がん悪液質に対しての有効な治療法は、2021年4月にアナモレリン塩酸塩が承認されるまで存在しなかった。アナモレリンの薬理作用は、グレリン受容体に作用して脳下垂体での成長ホルモン（GH）の放出と視床下部での食欲亢進による筋肉量および体重増加作用と考えられている。一方で、アナモレリン塩酸塩は新薬のため、使用患者数も少なく薬剤に関する情報は添付文書やインタビューフォームに限られる。そこで、今回、がん悪液質を発症した進行膵臓がん患者の味覚障害がアナモレリン塩酸塩の投与により改善し、QOLの向上を認めた症例を経験したため報告する。
Magnesium oxide, a low-price laxative without a habit-forming tendency after long-term use, is widely used for treating constipation in Japan. However, its use has been associated with hypermagnesemia in patients with impaired magnesium excretion function such as renal insufficiency. Therefore, in this study, we investigated the use of magnesium oxide tablets, which may be administered to the elderly on a long-term basis. We found the total number of prescriptions has increased year by year and exceeded 4 billion tablets in FY 2020. The use and number of prescriptions were highest among individuals in their 80s, and more than 70% of patients taking the drug are aged 70 years or older. Since the elderly experience physiological functional decline, pharmacists must make effective use of not only age but also laboratory data listed on prescriptions when dispensing these medications in order to prevent adverse events.
Hyperlipidemia is a risk factor for arteriosclerotic disease. Fibrates have been used as therapeutic drugs for hyperlipidemia. Pemafibrate, a novel fibrate, is a selective peroxisome proliferator-activated receptor α modulator that is prescribed to patients with renal dysfunction owing to its unique metabolism and excretory profiles. However, there is limited information on its use in patients with renal dysfunction, which is a risk factor for adverse events in these patients. This study investigated the effect of administering 0.1 mg of pemafibrate once daily to dyslipidemic patients with chronic kidney disease (CKD) that had progressed to stages G3b or G4. A total of six patients were included in this study and a comparison of clinical laboratory data before and after 12 months of pemafibrate administration was performed. The effects of pemafibrate on triglyceride (TG), aspartate aminotransferase, alanine aminotransferase (ALT), lactate dehydrogenase, creatine kinase, serum creatinine, uric acid, hemoglobin A1c levels, and estimated glomerular filtration rate were examined. Of all the measured parameters, TG and ALT levels decreased over time, but there was no clear effect on the other parameters. These results show that once-daily 0.1 mg pemafibrate can be a potential treatment option for patients with CKD. However, the study needs to be extended to a larger population to validate the findings.
The medical costs in Japan are rising owing to an increasing number of aged population and advances in medical technologies. Thus, there is an urgent need to reduce the ever- increasing medical costs while ensuring a high quality of medical care. Many countries adopt a policy for suppressing medical costs by promoting the usage of generic drugs that are less expensive than branded drugs. The present study investigated the effect of the recently introduced authorized generic (AG) system in Japan on the patients’ preference in switching the branded product of rosuvastatin, one of the first-line treatment for dyslipidemia drugs, either to the AG or non-AG products in a community pharmacy, Funabashi, Chiba. The results showed that 64.3% of the respondents preferred to use generic drugs, and those who preferred to use branded drugs were significantly older than those who preferred to use generic drugs (p=0.004). After the pharmacists’ counselling patients about AG and non-AG (standard) generic drug, 60% of patients who initially chose the branded product switched to AG drug. In conclusion, pharmacists’ adequate guidance and awareness to patients about AGs and non-AG (standard) generic drug may promote the use of generic drugs.