Uremic pruritus is a very common condition for patients on hemodialysis (HD), considered to decrease QOL and impair the prognosis of those individuals. We herein investigated the efficacy and the proper use of nalfurafine, a new kappa-opioid receptor agonist, on HD patients. Twenty-five HD patients receiving nalfurafine were enrolled in this study after appropriate informed consent. The administration of nalfurafine was once halted and the subjects’ symptoms were monitored, which included itching and sleep disturbances. The concomitant drugs and the cost-benefit effect were also investigated. Thirty-six % of patients were administered nalfurafine as a first choice. Surprisingly, the cost for total medication was reduced to 45% during an interrupted period of nalfurafine, an extremely expensive drug. Only 7 out of 25 patients (28 %) chose the resumption of nalfurafine after a 2-week interruption. Thus, it is necessary to evaluate the use of nalfurafine periodically in terms of the validity and health cost-effectiveness of this drug.

The dose adjustment of medicines is important for renal excretion-type drugs in chronic kidney disease (CKD) patients. However, community pharmacy pharmacists, who cannot look at the laboratory values of CKD patients, depend on information from patient interviews about kidney function decline. A system for cooperation over the CKD information of patients is established in Nagasaki Prefecture, in which community pharmacy pharmacists will be given patient CKD information with the affixing of a CKD stamp to the medicine notebook of the patient by a kidney specialist.We performed an attitude survey on information cooperation with a CKD stamp on hospital pharmacists and community pharmacy pharmacists. Most hospital pharmacists and community pharmacy pharmacists answered positively to the idea of taking part in the cooperation system of CKD information with a CKD stamp. There were positive responses about the intention to cooperate in the information cooperation system with a CKD stamp. The communication tool of a CKD stamp was judged to be effective for the appropriate use of drugs and medicines by the hospital pharmacists and community pharmacy pharmacists.

[Purpose] We examined the area under the blood drug concentration-time curve (AUC) of varenicline in low-body-weight smokers with renal dysfunction.[Methods] We estimated the probability that the AUC may exceed 200, 250, 300, 350, or 400 ng・h/mL with respect to the dose of varenicline (2.0, 1.5, 1.0 mg/day) in patients with a body weight of 65 or 55 kg and creatinine clearance (CLcr) of 100, 60, or 40 mL/min by performing 10,000 sessions of Monte Carlo simulation based on population parameters. The effective AUC range was set at 200 to 300 ng・h/mL, and the nausea/vomiting appearance range at 300 ng・h/mL or more.[Results] The probability that the AUC may exceed 300 ng・h/mL was 0.1% when estimating it under the following conditions: body weight, 65 kg; dose, 2.0 mg/day; and CLcr, 100 mL/min. In patients with a CLcr of 40 mL/min, it was 100%. When administering varenicline at 1.5 mg/day to patients with a CLcr of 40 mL/min, the probability that the AUC may exceed 200 ng・h/mL was 99.9%. The probability that it may exceed 300 ng・h/mL was 34.0%.The probability that the AUC may exceed 200 and 300 ng・h/mL was 89.7 and 3.7%, respectively, when estimating it under the following conditions: body weight, 55 kg; dose, 2.0 mg/day; and CLcr, 100 mL/min. In patients with a CLcr of 60 mL/min, the probability that it may exceed 300 ng・h/mL was 84.2%. When administering varenicline at 1.5 mg/day to patients with a CLcr of 60 mL/min, the probability that the AUC may exceed 300 ng・h/mL was 8.6%. When administering varenicline at 1.0 mg/day to patients with a CLcr of 40 mL/min, the probability that it may exceed 200 ng・h/mL was 78.4%. The probability that the AUC may exceed 300 ng・h/mL was 2.9%.[Conclusion] Of patients weighing 65 kg, it was necessary to consider dose reduction to 1.5 mg/day in those with a CLcr of 40 mL/min. When weighing 55 kg, this was necessary in those with a CLcr of 60 mL/min. Dose reduction to 1.0 mg/day was necessary in those with a CLcr of 40 mL/min.