Tramadol is a weak opioid analgesic indicated for the treatment of moderate to severe cancer pain at step 2 of the WHO analgesic ladder. There is little experience of its use in Japan; there are few reported detailed surveys on the usage of tramadol and its usefulness in patients who changed from taking tramadol to taking stronger opioids. The present study included inpatients who took tramadol hydrochloride capsule for cancer pain in the Nagoya University Hospital between October 2011 and March 2014; these patients were retrospectively examined based on electronic medical records. We observed that, out of 143 patients, 101 (71%) were started on a dose of 100 mg/day tramadol. Fortyeight of these 101 patients (48%) were changed to administration of stronger opioids, of which only 4 patients had their tramadol dosages increased to 300 mg/day before being changed to stronger opioids. However, among patients whose administration was changed from tramadol to stronger opioids, the incidences of nausea/vomiting when changing drugs were significantly lower than that among patients who had not taken tramadol (tramadol used group 19.4% vs non-tramadol used group 41.5%: P < 0.05). These results indicate that the incidence of nausea/vomiting may be reduced when changing from taking tramadol to taking stronger opioids after having used tramadol.
Polypharmacy, the co-prescribing of nonessential drugs and inappropriate prescriptions, is a worldwide issue and is a factor affecting the increase in adverse drug reactions, drug-drug and drug-disease state interactions, and the growth in medical spending. In this study, we evaluated the current status of polypharmacy in elderly patients at Kobe University Hospital and the efficacy for screening and intervention against potentially inappropriate medications (PIMs) with the screening tool of older persons' potentially inappropriate prescriptions (STOPP) criteria formulated by a pharmacist. Of 301 study patients, 81 (26.9%) patients with PIMs were identified using the STOPP criteria, and these patients had a significantly higher number of prescribed drugs than other patients. Moreover, there was a correlation between the number of prescribed drugs and the percentage of patients identified using the STOPP criteria. The STOPP criteria identified 125 cases to be PIMs, and the prescriptions were changed for 35 (28%) of them. In 125 cases of PIMs, 61 cases had been strongly recommended prescription changes by pharmacists, of which 32 cases (52.5%) had been changed. Several prescription changes were often associated with the administration of nonsteroidal anti-inflammatory drugs. Based on our findings, we suggest that the STOPP criteria are useful for screening PIMs in Japanese patients and are a helpful tool for managing polypharmacy. The benefits of this approach for pharmacists should be multilaterally evaluated by the assessment of patients and medical economic outcomes in the future.
Atypical antipsychotics are less likely to cause extrapyramidal symptoms (EPS) compared to typical antipsychotics. However, recent studies have suggested that both atypicals and typicals produce a similar risk for EPS. We performed data mining using the Japanese national insurance claims database (NDB) constructed by the Ministry of Health, Labour and Welfare in Japan. Sequence symmetry analysis was performed to identify the risk of EPS after antipsychotic use. In this study, antiparkinsonian drugs with anticholinergic action were used as a marker of EPS. Antipsychotics in combination with antiparkinsonians was examined by prescription sequence symmetry analysis (PSSA). Likewise, event sequence symmetry analysis (ESSA) was undertaken to evaluate the association between antipsychotics and EPS diagnosis. Adjusted sequence ratios (ASRs) with 95% confidence intervals (CI) were calculated. In PSSA, significant associations with antiparkinsonians were found for the whole class of antipsychotics and atypicals with ASRs of 4.82 (95%CI 4.74-4.91) and 2.97 (2.93-3.01), respectively. A significant association between typicals and antiparkinsonians was not found. In ESSA, significant associations with EPS were found for the whole class of antipsychotics and atypicals with ASRs of 1.67 (1.65-1.69) and 1.49 (1.47-1.50), respectively. A significant association between typicals and EPS was not found. The number of patients who were prescribed atypicals first was 1.5 times larger than the number of patients who had typicals initially prescribed. Analysis of NDB demonstrated that antipsychotics increase the risk of EPS. Significant associations between EPS and atypicals (but not typicals) were found. This finding may be attributed to the prescribing sequence of antipsychotics.
Recent reports indicate that statin therapy is associated with a high risk of developing diabetes mellitus. The aim of this study was to evaluate the effect of statins on impaired glucose tolerance. Spontaneous reporting systems, such as the Food and Drug Administration Adverse Event Reporting System (FAERS) and the Japanese Adverse Drug Event Report (JADER) database, are used for pharmacovigilance studies. We evaluated the association between each drug and adverse event on the basis of the number of cases and reporting odds ratio (ROR), and Weibull distribution parameter for the time-to-onset analysis. FAERS contained 5,821,716 reports, and after excluding duplicate data, 4,551,642 reports were analyzed. The number of reports related to impaired glucose tolerance was 388,668. The RORs of impaired glucose tolerance events for atorvastatin, rosuvastatin, simvastatin, pravastatin, fluvastatin, and pitavastatin were 2.9 (95% confidence interval [CI]: 2.8-2.9), 1.6 (1.5-1.7), 0.9 (0.8-0.9), 0.9 (0.8-1.0), 1.3 (1.0-1.6), and 1.2 (0.6-2.4), respectively. The RORs from this database indicate that impaired glucose tolerance is likely associated with atorvastatin and rosuvastatin use. The JADER database contained 338,224 reports. The median time-to-onset of impaired glucose tolerance for atorvastatin, rosuvastatin, simvastatin, pravastatin, fluvastatin, and pitavastatin use was 144, 35, 123, 308, 304, and 370 days, respectively. Since the shape parameter β of Weibull distribution for all statins was less than 1, hazard was considered to decrease over time that are classified as early failure type. Our results emphasize the need for clinicians to closely monitor impaired glucose tolerance in patients receiving statins.
In patients with osteoporosis, discontinuation of long-term drug administration is an important issue in therapy. To investigate this problem, in 9 pharmacies in Toyama, we asked patients who were taking a new type of Alendronate drug, Alendronate Sodium oral jelly (Bonalon® Oral Jelly), about their feelings. Their feelings were evaluated according to a 5-grade system (1: bad to 5: good) and analyzed by customer satisfaction analysis. The mean of comprehensive impression, indicating the degree of satisfaction, was 3.94. Ease of swallowing, ease of taking out from package, and softness of jelly influenced a good impression. On the other hand, the size of jelly had a negative correlation with comprehensive impression. In patients requiring long-term care, using a nauseous medicine and a medicine that is difficult to take from the package induces non-compliance with the drug-taking regime. The new oral jelly was rated as having a good impression in the feeling of use. This result indicates that using this jelly might help to reduce non-compliance in long-term drug administration in osteoporosis patients.
In a Health Festival for citizens, we examined risk factors for chronic obstructive pulmonary disease (COPD) with the lung age estimated by a spirometer measurement, and evaluated an attitude survey for COPD and the International Primary Care Airway Group (IPAG) questionnaire. The lung age difference (lung age - actual age) of a smoker was significantly increased in comparison with that of the nonsmoker. We analyzed the correlation of the lung age with the IPAG questionnaire point, and found a meaningful correlation between these statistically. However, there was no correlation of the lung age difference with the IPAG questionnaire point. It is said that the IPAG questionnaire point is related to the risk of COPD onset, but the guidelines that we used were based on the parameters for Westerners, and it is thought that re-examination of the parameters is necessary to adapt the guidelines for Japanese. The physical assessment of smokers by a pharmacist using a spirometer accompanied by estimation of the lung age was effective for recognizing the risk of COPD onset, and serves as an incentive to stop smoking.
We experienced the case of a woman with colorectal cancer in the end period being treated by a community palliative care team and hospital pharmacists, using a medical social networking service (SNS). The patient was experiencing somnolence, disturbance of consciousness and convulsion-like attacks at discharge. Based on information on the patient exchanged through SNS, we judged that she was receiving an excess dose of narcotic analgesics, and after suggesting a reduction in the dose of oxycodone, her level of consciousness and attack symptoms improved, and she experienced a painless condition. By using information sharing systems to support community palliative care teams, including community pharmacists, hospital pharmacists can contribute to the development of effective community medicine.
An immunosuppressant, mizoribine, is absorbed in the intestine via Na+-coupled concentrative nucleoside transporter (CNT). However, our previous clinical research indicated that orally administered mizoribine is absorbed well even under fasting condition. In the present study, we investigated the intestinal absorption mechanisms of mizoribine without sodium intake. We evaluated the extent of mizoribine intestinal absorption and the sodium concentration in intestinal lumen in rats using an in situ closed loop method. In addition, we evaluated the secretion mechanisms of sodium into intestinal lumen. The absorption of mizoribine in the absence of sodium administration decreased slightly as compared with the absorption in the presence of sodium administration. Nitrobenzylmercaptoprine ribonucleoside, which is an inhibitor of sodium independent equilibrative nucleoside transporter (ENT), significantly reduced the absorption of mizoribine in the absence of sodium administration. The sodium concentration in the intestinal lumen increased rapidly up to 120 mM. Amiloride did not affect the sodium concentration in the intestinal lumen. Therefore, sodium/proton exchanger was unlikely to contribute to the secretion of sodium into the intestinal lumen. These findings suggest that sodium is secreted rapidly into the intestinal lumen, and that CNT and ENT function cooperatively on the intestinal absorption of mizoribine even without sodium intake.