Tramadol and low-dose oxycodone is used for moderate cancer pain. There are no reports comparing oxycodone and tramadol in patients with cancer pain in the second step of the WHO pain ladder. We conducted a clinical trial of low dose oxycodone versus tramadol for the initial control of patients with moderate cancer pain. Tramadol was equivalent to oxycodone in pain improvement rate and titration completion rate. However, the incidence of side effects was lower in the tramadol group. The rate was 13.3% in the tramadol, and 81.2% in the oxycodone. In conclusion, the results of this trial suggest that tramadol has a lower risk of side effects than oxycodone.
Medication notebooks are highly evaluated as tools for sharing medication information among medical institutions. Using the notebook, the history of ethical drugs is managed, but the history of over-the-counter (OTC) drugs and health foods is seldom managed. We investigated the effect of patient education on discharge for medication-notebook use on purchasing OTC drugs and health foods. Patients aged ≥ 20 years who were hospitalized at the Department of Ophthalmology of Gifu Municipal Hospital between October 16, 2013 and February 28, 2014 (n = 136) were allocated randomly to an intervention group with the education and a control group without the education, and we performed questionnaire surveys before the education and at 2 months after discharge. The education explains the importance of medication-notebook use on purchasing OTC drugs and health foods and recommends appropriate use. The questionnaire covers the use of OTC drugs and health foods, the purchase of them in pharmacy/store and by Internet/mail-order, and medication-notebook use at the time, etc. The rate of medication-notebook possession was 82.3% in total, and the rate of the notebook use on purchasing OTC drugs and health foods in pharmacy/store and by Internet/mail-order was 0% each before the education. The rate of patients who got to use the notebook on purchasing OTC drugs or health foods in pharmacy/store or by Internet/mail-order in 2 months from discharge was 30.0% in the intervention group and 0% in the control group (P = 0.020), revealing that patients got to use a medication notebook on purchasing OTC drugs and health foods spontaneously as a result of receiving the education.
The large variability of the bioavailability (F) of mizoribine accelerates the positive correlation between the apparent volume of distribution (V/F) and the oral clearance (CL/F). The aim of the present study was to assess whether the variable F of mizoribine in healthy adult men is one of the factors in the interindividual pharmacokinetic variability of the drug. The serum concentration data of mizoribine were analyzed by the nonlinear mixed effects model program with first-order (FO), first-order conditional estimation (FOCE), and Laplacian methods. The 1-compartment model with absorption lag time and first-order absorption fitted well with healthy adult data, and there was a significant positive correlation between V/F and CL/F. The performance of FO method analysis for adult data was deteriorated considerably by misspecification of the random effect, whereas the FOCE method was robust for model misspecification. On the other hand, the performance of FOCE method analysis for the data obtained from pediatric patients with renal diseases was inferior to that of quasi-gold-standard Laplacian method analysis, probably because of the flip-flop problems in the conditional (Bayesian) estimation step of the FOCE analysis. The present findings confirm that F of mizoribine is variable in the healthy adult population, and also suggest that conditional estimation (FOCE and Laplacian) methods should be utilized positively and carefully while considering their advantages and disadvantages.
A new administration fee was introduced for the clinical activities of hospital pharmacists responsible for inpatient pharmacotherapy monitoring in medical institutions in April 2012 in Japan. In September 2012, in Okayama University Hospital, we established prescription-support based on a protocol for physicians on the Neurosurgery Ward. The pharmacist assessed the “status of the patient” and “medication adherence,” and then subjectively decided on “continuing administration,” “medicine withdrawal,” “changing the method of dispensation (one-dose-package or powdered medicines),” and “changing the dosage form.” In this study, to verify the effect of the intervention for prescription-support based on the protocol, we investigated the number of revised prescriptions and the contents of revision in the periods of June-August 2012 and June-August 2013. The results of investigation revealed that the pharmacists significantly contributed to reducing prescriptions from 84 (changed medicine: 1, changed administration and/or dosage: 5, changed dosage form: 3, changed method of dispensation: 25, discontinued prescription: 50, respectively) to 10 (changed administration and dosage: 1, discontinued prescription: 9) (P < 0.001). The total amount of drug fees decreased from 63,732.68 to 2,148.65 yen. According to the questionnaire survey of neurosurgeons on the ward, the pharmacists were highly evaluated regarding the “efficiency of work,” “improvement of medical safety,” and “improvement of medication quality.” In conclusion, the pharmacists provided individual patients with optimized prescriptions, and markedly contributed to assuring the safety and efficacy of treatment with medication.
Medication compliance instructions in a community pharmacy should be carried out according to each patient's needs. However, much information needs to be imparted to patients, but it is difficult to provide sufficient explanations within the typically limited time constraints. Therefore, pharmacists might not be providing sufficient information to their patients when giving medication compliance instructions. In this study, in order to investigate the differences between the perspectives of patients and that of community pharmacists on the contents of medical compliance instructions, we investigated the importance and implementation ratio using a questionnaire asking what each considers important. The results indicated that all medication compliance instruction items are considered important by both patients and community pharmacists. On the other hand, the implementation ratio of medication compliance instruction items by community pharmacists was higher than the received ratio of medication compliance instruction items of patients in almost all the items except “Q14: the patient's own disease” and “Q16: the necessity of community pharmacists in medication compliance instructions etc.” Furthermore, there were some differences in emphasis between patients and community pharmacists. Particularly in “Q3: generic medicines,” “Q7: attention in life,” and “Q10: laboratory data,” the importance and implementation or received ratio were reversed between patients and community pharmacists. In conclusion, the matter of concern from the perspective of medication compliance instructions between patients and community pharmacists was illustrated by a comparative surveillance. It would be possible to create ideal improved medication compliance instructions suitable for the patient's needs based on the information derived from this type of assessment method.
Optimal blood pressure (BP) control is extremely important because hypertension is a risk factor for stroke, and heart and blood vessel disease. We have been performing periodic health consultations with collaboration among pharmacists and physicians in a doctorless area. We here report three cases in which these consultations contributed to improvement in hypertension. The first consultation involved a woman in her 70s who feared starting an antihypertensive drug after hypertension had been diagnosed during a medical checkup. After introducing interventions based on lifestyle modifications and home BP measurements, her BP stabilized without medication. The second consultation, with a woman in her 50s, had been taking tofisopam and captopril for autonomic nervous symptoms and hypertension, respectively. The consultation occurred after she had redeveloped marked hypertension caused by ceasing tofisopam of her own accord. She agreed to resume taking this drug again, after which her BP dropped to normal levels. The third consultation, with a woman in her 80s, was suspected of having hypertension induced by pseudo-aldosteronism caused by long-term use of an herbal medicine containing licorice. We recommended consultation with a primary care doctor, after which she discontinued taking the herbal medicine. Health interviews, active listening, BP measurement, and recommendations for lifestyle modifications and appropriate drug use provided by pharmacists, as well as coordination with primary care doctors and medical specialists, are useful for managing hypertension in residents of doctorless areas.
Differences in the anti-inflammatory effects induced by brand-name and generic ketoprofen tapes have not yet been examined. The aim of the present study was to investigate the anti-inflammatory effects of 9 ketoprofen tapes on rat carrageenan-induced paw edema and also determine the amount of ketoprofen released from these tapes. The suppression of carrageenan-induced paw edema more than 3 hours after the tapes had been applied was significantly stronger with the 4 ketoprofen tapes tested than with the control. The brand-name product released the highest amount of ketoprofen 3 hours after the tapes had been applied. The amount of ketoprofen released from the brand-name product was higher than that by 4 out of the 8 generic products tested. Furthermore, a correlation was found between anti-inflammatory effects and the amount of ketoprofen released 3 hours after applying the ketoprofen tapes (r = 0.552). Thus, the biological equivalents of generic products should be considered because the anti-inflammatory effects and amount of ketoprofen released differed between the brand-name and generic ketoprofen tapes.
We evaluated the sustained effect of a two-week hospitalized educational program for diabetes with a clinical path that was performed in our hospital from 2008. The HbA1c levels of patients who received the educational program were remarkably reduced in comparison to the levels just before receiving it and a significant reduction was seen by 12 months later, suggesting that the program has continuous effects. However, the mean of HbA1c levels 12 months after entered the range requiring moderation. To acquire a more durable effect, we examined factors that influence the blood sugar control levels at 12 months later. In the group with a good control, the ratio of patients who had diabetes diagnoses within the last ten years or received no medication was higher. This result indicates the importance of early education. In comparison with the good control group, the patients who belonged to the poor control group at 12 months later had already got significantly higher HbA1c levels by 3 months later. And the rise of HbA1c levels in the poor control group accelerated over time. Therefore, the early intervention and regularly approach to patients after the educational program would contribute to improving the educational efficacy. In the present study, it was revealed that appropriate education intervention for diabetic patients at an early stage brought a good curative effect.