Microcrystalline cellulose (Avicel®PH-302),lactose (Super-Tab®),carboxymethyl cellulose (CMC) and xylitol are added to tablet formulations of precipitated calcium carbonate to achieve rapid disintegration while maintaining sufficient tensile strength,and to allow tablets to be easy to take.We prepared tablets containing 200 mg of precipitated calcium carbonate by the direct compression method and measured their tensile strength,wetting rate and disintegration time.Though precipitated calcium carbonate gave tablets a greater hardness and disintegration time than tablets containing no precipitated calcium carbonate,the disintegration time in the human oral cavity was short enough for them to be rapidly disintegrating tablets.On investigating a correlation between disintegration time in vitro and disintegration time in the oral cavity,we found that disintegration time in vitro was a fairly good predictor of disintegration time in the oral cavity.The sensory test score for the calcium carbonate tablets was excellent.In addition,we demonstrated that it was possible to produce rapidly disintegrating tablets containing precipitated calcium carbonate produced by direct compression when CMC is used as a disintegrant and Super-Tab® and Avicel®PH-302 are used as excipients.

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Owing to the possibility of postoperative infections after off-pump coronary artery bypass grafting (OPCAB),early mobilization is a major aim of postoperative management.Postoperative infections and other major postoperative complications can pose a serious clinical problem.In view of this,using retrospective analysis,we investigated the number of times a non-steroidal anti-inflammatory drug (NSAID) was used up to postoperative day 3,as well as the statuses of progress of cardiac rehabilitation and dietary intake on postoperative day 3 in patients undergoing primary OPCAB (N=2citation=39)between April 2008 and November 2009.In addition,to investigate the relevance of changing Cefazolin (CEZ) to another drug in preventing postoperative infections,each patient was assigned to one of the following 2 groups : those treated with CEZ,both before and after surgery (CEZ non-replacement group) ; and those treated with antibiotics other than CEZ after surgery (CEZ replacement group).
We found that the rates for accomplishment of cardiac rehabilitation step 1 and intake of more than 30 percent of dietary intake on postoperative day 3 increased as frequency of NSAID use until postoperative day 3 increased.Furthermore,significant differences were noted for number of times an NSAID was used each day until postoperative day 3,cardiac rehabilitation step and postoperative dietary intake between the CEZ non-replacement group and CEZ replacement group.
These results indicate that active NSAID use was effective in achieving early cardiac rehabilitation,increasing dietary intake after OPCAB as well as in preventing postoperative infections.

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Nausea and vomiting due to chemotherapy not only reduce quality of life but also cause suspension or extension of therapy,or reductions in the dosages of agents used,and influence therapeutic effects.Their control is therefore extremely important.In Olanzapine,one of the multi-acting receptor-targeted antipsychotics,which produce an antimetic effect by acting as an antagonist against multiple receptors related to the mechanism of nausea and vomiting,could be effective in this regard.It is mentioned in the guidelines of the National Comprehensive Cancer Network.
In the present study,for patients who developed nausea and vomiting in the initial course of chemotherapy,Olanzapine was administered at 2.5 mg/day from the day prior to the 2 nd course of chemotherapy for 7 days.A comparison of acute and delayed nausea and vomiting symptoms between the initial and 2 nd courses of chemotherapy showed that Olanzapine had no additional effect against acute symptoms but for delayed symptoms,there was a significant improvement in the severity and period of nausea and vomiting.In the future,it will be necessary to accumulate data for many cases in order examine the safety of Olanzapine and dosages for it.

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For the sterilization of admixtures of anti-cancer drugs it is common to use a 0.2μm syringe filter (0.2μmF).However,highly viscous drugs such as 5-Fluorouracil (5-FU),require pharmacists to apply considerable pressure on the syringe plunger.In an effort to mitigate this,an 0.8μm syringe filter (0.8μmF) was empirically selected for testing with working time and filtration pressure as endpoints.First,we developed equations for a correlation between flow rate and filtration pressure using a simulated apparatus consisting of a 50 mL syringe containing 35 mL of 5-FU.The apparatus was used to record filtration pressures measured across both the 0.2 and 0.8μmF.The correlation equations for 0.2μmF (2 different manufacturers) were y=2.53 x (r=0.999)and y=1.50 x (r=1.000) and for 0.8μmF (2 different manufacturers) y=0.27 x (r=0.999)and y=0.25 x (r=0.998),respectively.Next,35 mL of the 5-FU in the 50 mL syringe was delivered by 10 pharmacists using either the 0.2μmF or 0.8μmF,and the time required to complete filtration recorded.5-FU filtration pressures were calculated using the equations.Working times and filtration pressures were 31.3±6.8 sec,176.1±34.9 kPa and 17.4.±5.0 sec,194.0±54.9 kPa for 0.2μmF,while those for 0.8μmF were 7.6±2.3 sec,80.9±23.0 kPa and 7.1±1.9 sec,79.9±19.3 kPa,respectively.Finally,35 mL of 5-FU was delivered by 10 pharmacists using 0.2μmF for 10 seconds,avoiding fatigue,and the amount of filtrates recorded.Filtration pressures were again calculated using the equations.The pressure at which there was no feeling of fatigue was 75±14 kPa.These results indicate that there would definitely be a reduction in fatigue with the use of an 0.8μmF for 5-FU.

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The purpose of this study was to identify the risk factors and subjective symptoms of drug-induced renal damage.Through a search of the CARPIS (Case Reports of Adverse Drug Reactions and Poisoning Information System) database,which contains over 47,000 case reports of adverse drug reactions,we obtained 476 cases of drug-induced renal damage which were assigned to a case group.We also selected 1,420 non-renal adverse reactions at random and assigned them to a control group.Logistic regression analysis revealed that the patient background factors of child (age : 0-15 years) (odds ratio (OR)=1.92 ; 95% confidence interval (95% C.I.)=1.35-2.71),infection (OR=1.49 ; 95% C.I.=1.06-2.07)and renal damage (OR=2.80 ; 95% C.I.=1.70-4.54)were associated with a significantly greater risk of developing drug-induced renal damage.In addition,bucillamine (OR=18.39 ; 95% C.I.=7.89-48.47),propylthiouracil (OR=9.36 ; 95% C.I.=3.7025.42),penicillamine (OR=7.14 ; 95% C.I.=3.06-17.20)and diclofenac (OR=6.07 ; 95% C.I.=2.72-13.76),and cisplatin (OR=9.69 ; 95% C.I.=4.40-22.03)were found to significantly raise the risk of drug-induced renal damage.Edema,hematuria and oliguria were also significantly associated with drug-induced renal damage.These results will be useful in the community pharmacy setting.

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Super selective intraarterial injection using cisplatin (CDDP) is considered to be a treatment of choice for head and neck cancer.However,a problem with this treatment is pain occurring at the injection site due to the low pH of the CDDP solution for injection and it has therefore been recommended that CDDP solution be diluted to a ratio of 20:1 with sodium bicarbonate solution to neutralize the acidity.However,the recommended dilution ratio is not applicable because the standard pH of CDDP solutions varies from 2 to 5.5 and concentrations of CDDP and sodium bicarbonate in injectable solutions have not been examined in any previous study.
In view of this,we measured pH values to determine the optimal mixing ratio for CDDP (25 mg/50 mL) and 8.4% sodium bicarbonate solution.We found that injectable CDDP solutions (25 mg/50 mL) made by 5 different manufacturers had different pH profiles and that the optimal mixing ratio for a CDDP and sodium bicarbonate solution varied with the content of each constituent and the manufacturer.In conclusion,it is necessary to vary the mixing ratio of these injectable solutions depending on product features.

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nsulin was added to a peripheral parenteral nutrition solution and its stability was investigated using high performance liquid chromatography.Though there was a decrease in insulin content over time,the level of decrease could not be explained only by previously reported findings such as adsorption on to the container or degradation due to a stabilizer.Further testing with different solutions revealed that glucose and amino acids were associated with a decrease in insulin content in the near-neutral pH range.
Based on these results,we investigated the stability of insulin when administered via a separate infusion line and found that infusion via a Y-site minimized the decrease in content.This is therefore recommended.

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Although drug costs account for a large proportion of the healthcare costs for patients with diabetes mellitus,drug costs in this population have not yet been exclusively studied.In view of this we evaluated a total of 128 patients with type 2 diabetes mellitus to determine relationships between the costs of drugs used to control blood glucose,blood pressure,and blood lipids and the total of such costs (referred to as diabetes-related drug costs) and patient characteristics.However,our study did not take into account the effects of diet therapy,exercise therapy and compliance on diabetes-related drug costs.
Average diabetes-related drug costs were 354.7±250.6 yen/day.The percentage costs of drugs used to control glucose level,blood pressure,and lipids were 47.8%,36.7%,and 15.4%,respectively,and costs for patients receiving insulin were 1.7 times those for patients only receiving oral drugs.No significant difference in diabetes-related drug costs was observed between elderly and younger patients but diabetes-related costs and blood pressure and lipid control-related costs for female patients were 1.3,1.6,and 1.8 times the costs for male patients,respectively.A comparison between diabetic patients with and without a family history of diabetes revealed that drug costs for blood pressure control were 2.8-fold higher in patients without a family history of diabetes.Further,significant relationships were observed between diabetes-related drug costs and HbA_1C,duration of diabetes mellitus,and systolic blood pressure.A multiple regression analysis revealed that age,systolic blood pressure,and presence/absence of insulin injections significantly affected diabetes-related drug costs.

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The aim of the present study was to derive an equation for estimating doses of renal-excretion drugs in neonates based on clearance ratios for neonates and adults as well as in consideration of postconceptional age (PCA).The following equation was derived for the estimation of neonatal doses taking PCA into account :
D_N=D_A·(1/fu_A+(1-fu_A)P_N/P_A)(0.23*(CWT/2)^0.691*(PCA/40)^3.23/4.9)
where D,fu,P,and CWT represent the dose,free fraction of drug in plasma,serum protein level,and current weight,respectively.The subscripts N and A indicate neonate and adult,respectively.We examined the validity of this equation using 2 renally-excreted antibiotics,arbekacin sulfate (ABK) and vancomycin chloride (VCM) as examples.For the evaluation,we compared the neonatal doses derived using our equation and Crawford’s equation.The established dose for each PCA based on a population parameter was used as the standard.The predictive accuracy of our equation was significantly higher than that of Crawford’s equation for neonates at gestational weeks 25,30,and 35.In conclusion,our findings suggest that a general equation taking PCA into account would be useful for calculating antibiotic doses in neonates.

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