Utilization of genetic information to achieve more appropriate use of drugs has not yet progressed, although a number of studies on the association between genetic polymorphisms and responses to drugs have been performed. Comparison among groups possessing different genotypes may give a significant difference in median responses to drugs, but little answer to the wide variation of drug response in patients sharing the same genotype. In fact, genetic information alone cannot accurately predict response to drugs in each individual. However, application of genetic information is often extremely useful to correct drug therapy to a more appropriate form in certain cases. Since pharmacists have to take responsibility for drug therapy in each patient, they should use all tools available including genotyping that may achieve better treatment. Nevertheless, since genetic information alone is insufficient to design better drug therapy in most cases at present, it is important to clarify factors, which should be considered together with genetic information. Clinical researches are indispensable to identify these factors. A simple genotyping method is a powerful tool to solve problems of drug therapy encountered at hospitals and/or to provide evidence through clinical studies on usefulness to apply genetic information to improve current drug therapy. The increase in the number of pharmacists, who are interested in not only drugs but also the genetic character of patients, is expected to contribute to better drug therapy in the future.
In recent years, cancer chemotherapy has been shifted from inpatients to outpatients. In outpatient cancer chemotherapy, patients manage side effects by themselves. Therefore, it is very important that pharmacists provide information of side effects to patients. In Shiga University of Medical Science Hospital, pharmaceutical care to all outpatients by pharmacists was started from October 2010. However, starting the service incurred some problems. One of them was understaffing. When we constructed a novel original outpatient chemotherapy system, the manpower shortage problem was dispelled. Throughout this service, various symptoms caused by chemotherapy were more significantly improved in intervention cases than in non-intervention cases. A medication leaflet was used when providing medical information for pharmaceutical care. It was also expected to provide information to medical facilities outside the hospital. We consider that the medical leaflet may contribute to promoting collaboration between hospital and community pharmacies.
We evaluated the photostability of azasetron hydrochloride injection (Serotone Injection) under several conditions (indoor, outdoor and other conditions). The evaluation revealed that the azasetron hydrochloride content remained 95% or more of the initial content even after storage in an indoor condition (with the window closed, but with exposure to high levels of direct rays). On the other hand, the drug content decreased markedly when the formulation was stored outdoors or in an indoor condition with the window open. When stored outdoors, exposed to direct rays, the drug content decreased to about 47% of the initial amount within only 30 minutes. When stored outdoors in the shade or indoors without exposure to direct rays, the content decreased by only about 25% or less of the initial content. We may therefore conclude that azasetron hydrochloride should be stored and used indoors with the window closed.
Fluoropyrimidines (FU) in combination with warfarin (WF) are reported to increase prothrombin time-international normalized ratio (PT-INR) and bleeding. In the present study, we investigated retrospectively the timing of expression of blood coagulation abnormality in 11 patients treated with WF and UFT or S-1 concomitantly in Okayama University Hospital and Ako City Hospital. In 11 patients, 6 were UFT in combination with WF (UFT group), 5 were S-1 in combination with WF (S-1 group). In all patients, PT-INR was significantly increased after combination with UFT or S-1. The PT-INR elevated rate of the S-1 group was 214.5% and its rate of the UFT group was 178.2%. The PT-INR elevated rate was higher in the S-1 group than in the UFT group. The PT-INR was increased 2.8 times after four months in the UFT group. These results suggest that the careful monitoring of PT-INR elevation and bleeding is necessary in patients receiving UFT in combination with WF as well as S-1 in combination with WF.
In the preparation of oral solutions, a mixture of syrup and dry-syrup formulations is often diluted with water in a prescription bottle to a desired volume using a graduated scale on the side of the bottle, by which patients measure each dose. Due to increased viscosity of the suspension mixture and limited solubility of dry-syrup formulations, the amounts of drug components contained in a dose may vary between measurements. In this study, we determined differences in the amounts of drug components in each measured dose of an oral solution containing a dry-syrup formulation prepared with different amounts of diluent. Regarding both dry-syrup and syrup formulations, on increasing the amount of diluent, differences in the amounts of the drug components in measured doses became smaller, while these differences became greater in relation to the viscosity of oral solutions. When an oral mixture was prepared with a small amount of diluent, its drug components were at a high level in the first dose but at a lower level in the last dose from a prescription bottle. These observations demonstrate that it is necessary for dose uniformity to use relatively higher dilutions of oral solutions to achieve an appropriate viscosity.
In this study, we surveyed the efficacy of erlotinib for patients who had been previously treated with gefitinib. The subjects comprised non-small cell lung cancer patients being treated with erlotinib, who had previously been treated with gefitinib, at the Nagara Medical Center from March 2008 to February 2012. A total of 11 patients were included, 8 of whom discontinued gefitinib treatment because of disease progression and 3 of whom discontinued gefitinib treatment because of hepatic disorder. Improved condition and suppressed disease progression were observed in 3 patients. The minimum value of time to treatment failure (TTF) was 12 days and average TTF was more than 136 days. Three patients who discontinued gefitinib treatment because of hepatic disorder did not develop severe hepatic disorder with erlotinib treatment, and they were able to continue erlotinib treatment. The minimum value of TTF for these 3 patients was 182 days and the average TTF was more than 250 days. One patient had discontinued gefitinib treatment because of hepatic disorder; however, since switching to erlotinib, suppressed disease progression has been apparent for more than 1 year without developing hepatic disorder. In conclusion, erlotinib treatment is one option for patients previously treated with gefitinib.
A barcode is printed on all injectable drugs, but not necessarily printed on other drugs. We compared the error rate for the dispensing support system of injectable drugs with that of oral drugs, and determined the introduction rate of barcode printing for oral drugs and external medicine. Using the dispensing support system, error rate was determined to be 0.0034% for oral drugs, while no error was detected in 348,514 prescriptions of injectable drugs. The results of the survey of pharmaceutical companies revealed that the rate at which the barcode was already printed or was proposed to be printed was 39%.The reasons for the lack of printing of the barcode for oral drugs were waiting for governmental regulation (41%), pharmaceutical company circles concerted action (23%), cost and lack of facilities (20%). It was thought that cooperation among pharmaceutical companies, administration and medical institutions is essential for introducing barcode printing of dispensing packages on all oral drugs and external medicine.
Since most antineoplastic agents have mutagenicity and teratogenicity, employment of a device for preventing exposure to these agents is recommended for their use. Chemosafe® is a new exposure prevention device manufactured by considering not only preparation but also administration and disposal processes of antineoplastic agents. In this study, we practiced processes from preparation to disposal employing the conventional method and the Chemosafe® approach to compare the level of cyclophosphamide contamination between the two methods, using cyclophosphamide as a model agent. In the preparation process conducted by 9 pharmacists, the use of Chemosafe® reduced scatter of cyclophosphamide to the inside of the cabinet and their chest areas, although it increased the scatter to their gloves and the vials. In the processes from administration to disposal conducted by 4 nurses, use of Chemosafe® reduced scatter of the agent to the bench and their chest areas, but scatter to their gloves was comparable. The exposure of gloves and vials to cyclophosphamide when using Chemosafe® may be attributable to cyclophosphamide retained in the joint of the syringe and the vial adapter. These results suggest that Chemosafe® may be useful for preventing the scatter of antineoplastic agents in the course of processes in which health care workers engage when dealing with these agents. Furthermore, because the joint of the syringe and the vial adapter can be sources of exposure, care must be exercised when handling the Chemosafe®.