Objectives: A refill-prescription system startedin April, 2022 in Japan. Refill-prescriptions can be usedrepeatedly, but pharmacists are required to check patients' medication and determine whether refills are appropriate. This study aimed to clarify the actual status of community pharmacies' treatment of prescription refills and pharmacists’ concerns about them.

Design: Questionnaire survey.

Methods: A self-administered questionnaire survey was conducted for pharmacists at community pharmacies from June to July, 2022, shortly after the refill-prescription system was launched, focusing on handling of prescription refills in community pharmacies, and concerns and challenges about refill-prescriptions.

Results: Responses were obtainedfrom 377 pharmacists in 34 prefectures throughout Japan. Among them, 30.8% had received refill-prescriptions. Many pharmacists checked medical histories, changes in patients' symptoms, and medication and medical examination status when determining the appropriateness of refills, but few reviewed past laboratory values or laboratory values measuredby patients themselves at the time of their pharmacy visit. Moreover, 34.8% of the pharmacies had internal rules for dealing with refills, and 39.8% had equipment to measure laboratory values. Many pharmacists were concerned about how to share patients’ information with other pharmacies. Challenges that were identified included “Determining whether the refill is appropriate for the patient” and “Establishment of a pharmacy system to receive refill-prescriptions”.

Conclusion: This study clarified the actual status of community pharmacies handling of prescription refills, and pharmacists' concerns or challenges about them. Potential improvements include increasing the number of devices that can measure laboratory values at pharmacies, improving home-use measuring devices, creating guidelines to determine the appropriateness of prescription refills and improving pharmacists' skills.

Objective: This study conducted a survey of the status of medicine adoption and appropriate use in hospitals. We compared the findings with 2015 survey results to evaluate the changes over time. We also evaluated the impact of changes in the current health care environment, including local community collaboration and the COVID-19 pandemic.

Methods: The survey included 500 randomly selected hospitals with more than 200 beds, over 50% of which are general ward beds, as well as 175 hospitals that were randomly selected from the respondents of the 2015 survey. The survey questionnaire included the number of medicines, availability of medication lists, adoption decisions, and impacts of local collaboration efforts and the COVID-19 pandemic on drug adoption and appropriate use.

Results: A total of 260 responses were collected from 675 hospitals (39% response rate). Of the 260 respondents, 90 were regional medical care support hospitals, 23 were special functioning hospitals, 143 were general hospitals other than those specified, and 4 were other hospital types. The average number of adopted medicines was 644 for oral medicines, 234 for topical medicines, and 228 for injectable medicines. Ninety-five percent of the hospitals used package inserts or interview forms when adopting medicines, but 15% used original articles. About 36% of the hospitals used standardized methods (hospital formulary management or protocol-based pharmacotherapy management), indicating a lack of pharmacists with pharmaceutical evaluation skills. As for local community collaboration regarding adopted medicines, the most common example was providing information to community pharmacists’ associations, and the most common method was sending information by e-mail, regardless of the hospital type. Regional collaboration meetings were few. The COVID-19 pandemic changed the method of obtaining drug information from pharmaceutical companies.

Conclusion: For hospital pharmacists, the selection of adopted medicines is one of the tasks of pharmaceutical management. There are urgent needs for the use of standardized methods and the training of pharmacists involved in the selection of adopted medicines. The establishment of a system to provide appropriate use of medicine to patients by standardizing the method of medicine adoption and information sharing is desirable.

Objective: Sennosides A and B, which are dianthrone glycosides contained in Rhubarb and Senna Leaf, exhibit laxative effect. Although a number of over-the-counter (OTC) drugs used as laxatives contain Rhubarb or Rhubarb and Senna Leaf, the total amounts of sennosides A and B are not mentioned in the package insert. To determine the total amounts of sennosides A and B in OTC drugs containing Rhubarb or Rhubarb and Senna Leaf, quantitative analyses of sennosides A and B were performed for 24 OTC drugs.

Methods: Sennosides A and B were extracted from 24 OTC drugs and quantitatively analyzed by high-performance liquid chromatography. Statistical analyses were carried out by a one-way analysis of variance followed by Dunnett's test or Tukey's test.

Results: The OTC drugs contained sennosides A and B in the range of 1.5-10 mg in the minimum daily dosage and in the range of 2.7-17 mg in the maximum daily dosage. In 11 of the OTC drugs (Products Nos. 1-5, 11, 12, and 15-18), the maximum daily dosage contained almost equal or higher amounts of sennosides A and B compared to that in a tablet of the prescription medicine Pursennid^® 12 mg. Furthermore, the amounts of sennosides A and B in the maximum daily dosage were significantly higher in products Nos. 1 and 11 and lower in products Nos. 8-10, 14, and 20-24 compared to those of a tablet of Pursennid^® 12 mg.

Conclusion: Although some OTC drugs have the same Rhubarb content, the total amounts of sennosides A and B can vary. Thus,there is no correlation between the Rhubarb content and total amounts of sennosides A and B. This is because of the inconsistent quality of Rhubarb and/or the differences in the manufacturing methods of the OTC drugs containing Rhubarb. Because the total amounts of sennosides A and B cannot be estimated based on the Rhubarb content, a constipated patient should start taking an OTC drug containing Rhubarb at the minimum daily dosage. It is also recommended that the total amounts of sennosides A and B are mentioned in the package insert of OTC drugs containing Rhubarb or Rhubarb and Senna Leaf.

Objective: Adverse reactions are sometimes induced by contrast media used for medical imaging and can be life-threatening. Thus, appropriate management is important for patient safety. The purpose of this study was to clarify the actual management of adverse reactions induced by contrast media in hospitals, the opportunities for intervention by hospital pharmacy departments and the attitudes of hospital pharmacists regarding the risk of adverse reactions.

Methods: A self-administered questionnaire survey was conducted in the pharmacy departments of 16 hospitals (approximately 200 to 1,000 beds) located in the Tokyo metropolitan area of Japan. The survey asked about the presence or absence of internal rules or manuals regarding contrast media administration at each hospital, the management status of patients with risk factors for adverse reactions, the opportunities for interventions by pharmacists, and the opportunities for discussion regarding contrast media administration among pharmacists and other professionals.

Results: Of the 16 hospitals, 10 responded to the questionnaires, and 7 of them had internal rules or manuals. These rules or manuals stipulated actions such as “do not administer contrast media” to patients with risk factor(s) for adverse reactions. For inpatients, there were opportunities for pharmacist interventions, such as drug management and guidance services and initial interviews upon hospital admission. However, for outpatients the opportunities for interventions were limited. At 5 of the 10 hospitals, pharmacists discussed contrast administration with physicians, radiologists, and other healthcare professionals.

Conclusion: The present study reveal that many hospitals take great care in deciding on the administration of contrast media to patients at risk of adverse drug reactions. Our results indicate that the limited opportunities for “outpatient intervention" is an issue in the hospital pharmacy department's participation for proper use of contrast media.

Objective: In Japan, the Guideline on Drug Interaction for Drug Development and Appropriate Provision of Information (GL) was notified in 2018. In the GL and the associated document, it was determined that package inserts of drugs which need to be categorized as precaution due to the significant degree of drug interactions by CYP3A inhibition should describe possible perpetrator drugs using designated expressions, such as “strong CYP3A inhibitor.” For contraindication, it was decided that all drugs should be described individually. In 2021, as supplementary information to the GL, a list of CYP substrates, inhibitors and inducers, classified based on interaction strength and CYP isoenzymes (i.e., the drug list), was published. In this study, we aimed to survey the information on drug interactions by CYP3A inhibition described in the package inserts based on information in the drug list, and to clarify the status and issues.

Methods: The package inserts of 24 substrate drugs of CYP3A with contraindications for itraconazole, a strong CYP3A inhibitor, were examined, and the descriptions of strong, moderate, and other CYP3A inhibitors were studied.

Results: The frequencies of contraindication for strong CYP3A inhibitors were cobicistat (75%), grapefruit juice (0%), ritonavir (92%), voriconazole (67%), clarithromycin (50%), ceritinib (0%), and posaconazole (33%). On the other hand, some CYP3A substrate drugs was contraindicated with moderate CYP3A inhibitors but not with these strong CYP3A inhibitors. Furthermore, 19 CYP3A inhibitors, which were not on the drug list published in 2021, were identified as contraindications for co-administration. Majority of these were protease inhibitors, and some have been discontinued or not available in Japan.

Conclusion: The findings of this study imply the necessity of organizing scientific description based on the GL strength classification. Moreover, it is important to disseminate the information and precautions for drug interactions provided in the package inserts to medical practice.

Objective: Pharmacists in inpatient pharmaceutical services are required to evaluate the medications that patients bring with them to the hospital when admitted and to make recommendations to physicians about these medications' proper use. Many hospitals perform such inpatient pharmaceutical services. Studies have found that pharmacists with insufficient years of experience are often put in charge of this practice. This has resulted in patients continuing to take inappropriate medications. We hypothesized that the involvement of another pharmacist in checking outpatient medications brought to the hospital might lower the rate of inappropriate use. We initiated the rechecking of medications brought to the hospital by the drug information (DI) pharmacist, based on the need for cooperation between the DI pharmacist and ward pharmacists.

Methods: We initiated rechecks by DI pharmacists of medications brought to the hospital and first checked by ward pharmacists, and estimated the medical economic impact of pharmaceutical intervention between 1 May 2019 and 30 April 2020.

Results: Within one year, the DI pharmacist suggested 15 interventions, including four interventions related to digitalis products and three related to direct oral anticoagulants. The medical economic impact was estimated to be 10,175,000 yen.

Conclusion: Our findings suggest that checking by another pharmacist of outpatient medications brought to the hospital is a useful addition to the check by ward pharmacists.