The proper use of drugs with renal excretion and nephrotoxicity is an urgent problem due to the increase in CKD patients. We have been sharing renal function data on CKD patients among medical staff, including community pharmacists, using the CKD sticker since March, 2012 in Shiga. The CKD sticker is affixed to the medication log book of CKD patients. We performed questionnaire surveys of all community pharmacies in Shiga for five years from 2012 to 2016, and examined the utility of the CKD sticker. The CKD sticker was recognized at 98.6％ of pharmacies in 2016. Pharmacies attended by patients with the CKD sticker increased to 68.8％ in 2016. In addition, there were no local differences among 9 branches in the Shiga Pharmacist Society in 2016. The number of pharmacies that performed questionable inquiries based on the CKD sticker increased from 7.7％ in 2012 to 24.7％ in 2016. Pharmacies that inquired about patients with CKD stickers greatly increased in 2016, and the number of prescription changes increased. The spread of CKD stickers was observed throughout the prefecture, and this study demonstrated that the CKD sticker was a useful tool for questionable inquiries. The CKD sticker helped to avoid the use of drugs in cases with nephrotoxicity and to reduce the quantity of drugs in cases with renal excretion, allowing for safe medication of CKD patients.
Metastatic renal cell carcinoma (mRCC) often becomes resistant to drugs, and therefore requires sequential treatment with different types of chemotherapeutics. Two agents used for the sequential treatment of mRCC, sunitinib (Su) and sorafenib (So), have been reported to achieve similar clinical efficacy regardless of the sequence in which they are applied. There are differences, however, in the costs associated with regimens. The present study aimed to clarify the optimal administration sequence of Su and So in terms of economic impact from the perspective of public medical care. The health outcomes were analyzed according to overall survival and progression-free survival. The clinical data were drawn from the results of a previous meta-analysis. in 2017. Total costs of each regimen were calculated from direct costs, which were derived from hospital receipts and medical records of patients who were diagnosed with mRCC at Yamagata University Hospital. The cost-effectiveness was analyzed by a Markov chain Monte Carlo method. Long-term patient outcomes and costs were assessed for each treatment option according to the relative incremental cost-effectiveness ratio (ICER). We found that the total gain in life-expectancy and projected cost of each regimen were, respectively, 24.5 months and 22,123,106 yen for Su-So, and 30.0 months and 30,994,113 yen for So-Su. The ICER of So-Su versus that of Su-So was 1,612,910 yen / month, with an incremental effect of 5.5 months. Compared with Su-So, So-Su provided better health outcomes over time; however, the cost was also higher.
Pseudohyperaldosteronism and associated hypokalemia are serious adverse effects caused by glycyrrhizinic acid (GA) present in Kampo medicines containing Glycyrrhizae Radix (GR); GA is the major component of GR. To obtain knowledge about the effective and safe use of Kampo medicines, we analyzed the quantities of GA in Kampo medicines by HPLC. The quantities of GA in 13 Kampo decoctions containing GR (2-6 g/day) were found to be almost 2-3.5 fold higher than those of the corresponding Kampo extract products. Among the Kampo extract products containing GR (3 g/day), the GA quantity in Shoseiryuto was significantly lower compared with that in the others, and Pinelliae Tuber as well as Schisandrae Fructus were found to contribute to the decrease in GA quantity. The GA quantity in the Yokukansakachinpihange decoction was found to be lower than that in the Yokukansan decoction; this was caused by the presence of Pinelliae Tuber and Citri Unshiu Pericarpium. Analysis of inter-product variations in GA quantities among the Kampo extract products revealed a maximum 2.6-fold difference in the quantities in the Shoseiryuto extract products from different companies. Our analyses show that GA quantities in Kampo medicines are influenced by the presence of concomitant crude drug constituents. This results in differences in GA quantities between decoctions and extract products having the same Kampo formula, and also among the Kampo extract products from different companies. It is recommended that GA quantities in Kampo extract products should be presented to prevent the adverse effects caused by GA.
Generic medicines are approved for clinical use without human studies evaluating the effectiveness and side effects. Allopurinol, a xanthine oxidase inhibitor, is often used for the treatment of hyperuricemia and gout, and some of its generic medicines are also approved for use in clinical situations. We retrospectively collected the information about patients with hyperuricemia and gout, who were prescribed only one kind of allopurinol in the first case. We also constructed an indirect response maximum drug inhibitory effect (Imax) model, based on the 634 serum uric acid (UA) levels of 148 patients, and were able to describe the time course of serum UA levels in patients during treatment with allopurinol. Before the initiation of treatment, the basal UA levels were increased in correlation with serum creatinine (SCr) concentrations. The inhibitory effects of allopurinol on the production of UA were attenuated by increase of the body mass index (BMI), but the Imax value differed significantly between males and females. The result of simulation analysis revealed that the achievement rate to decrease serum UA levels below 6.0 mg/dL (until 180 days after the initiation of treatment) was dependent on both the daily dosage of allopurinol and basal UA levels. However, there was no significant difference in anti-hyperuricemic effects of generic and brand-name allopurinol. Collectively, our constructed population pharmacodynamics model could describe the influences of BMI, SCr, and gender on serum UA levels in patients treated with brand-name allopurinol or its generic medicines, but anti-hyperuricemic effects did not differ significantly between brand-name and generic allopurinol.
Pictograms can be used to transmit information to anyone all over the world. In Japan, pictograms regarding interaction, usage, and dosage are developed by the RAD-AR Council Japan; however, pictograms indicating the pharmacological effect remain to be developed. In this study, we created seven kinds of pictograms regarding pharmacological effect: antiarrhythmic drugs, hypnotics, hypoglycemic drugs, antibiotics, diuretics, antihypertensive drugs, and antidementia drugs, and researched the necessity and evaluation of the created pictograms using a questionnaire survey for pharmacists and the general public. Overall, 89.6％ of the pharmacists and 86.8％ of the general public answered “necessary” regarding pictograms on pharmacological effects. Regarding the usefulness of these pictograms, pharmacists responded “understanding the efficacy of medicine” and “emergencies such as natural disasters.” On the other hand, the general public responded, “distinguish the medicine by myself” and “emergencies such as natural disasters.” The pharmacists had a significantly higher rate of giving correct answers than the general public for all pictograms. In the general public, the rates of correct answers for these pictograms decreased with age. However, the rates of correct answers for pictograms on diuretics and hypotensive drugs were > 90％ in the elderly aged ≥ 70 years. In conclusion, although the necessity for pictograms regarding pharmacological effects was proved, the correct answer rate differed significantly between the pharmacists and the general public. Therefore, it is necessary to improve these pictograms so that anyone can understand them more accurately, with or without medical knowledge.
The administration of tazobactam/piperacillin (TAZ/PIPC) to patients with renal failure requires dose reduction since it is eliminated through the kidneys. Therefore, we set TAZ/PIPC dose reduction criteria for the administration of TAZ/PIPC to renal failure patients; in addition, the pharmacist checked renal function and dose for proper use. We investigated the influence of the rate of renal failure patients administered TAZ/PIPC on antimicrobial use density (AUD), days of therapy (DOT), and AUD/DOT.
The rate of the number of patients administered TAZ/PIPC with renal failure, the rate of TAZ/PIPC dose and dosing days were calculated, and these variables were determined for each month of the study period. Furthermore, we assessed the correlations of AUD, DOT, AUD/DOT with the patient rate, dose rate and dosing days rate for each month. As a result, AUD/DOT was significantly and negatively correlated with patient rate (r = -0.634, P = 0.027), dose rate (r = -0.783, P = 0.003), and dosing days rate (r = -0.695, P = 0.012).
AUD/DOT is an indicator of the one-day dosing of antimicrobials. TAZ/PIPC one-day dose was correlated with renal function in 84.4％ of cases owing to the dose reduction criteria and checked by the pharmacist in this study. This suggests that the dose of TAZ/PIPC was appropriately adjusted based on renal function. We found that as the rate of administration of TAZ/PIPC, eliminated through the kidneys, in patients with renal failure increased, AUD/DOT decreased. Our findings support the appropriate assessment of antimicrobial dosage surveillance.
The clinical condition of patients in intensive care units (ICU) fluctuates significantly. The pharmaceutical-information service is provided by clinical pharmacists. However, the types of pharmaceutical information that merit intervention by clinical pharmacists in the intensive care field are unclear. In this study, we systematically constructed pharmaceutical-information services to clarify the condition in which intervention by clinical pharmacists is allowed for drug therapies in the intensive care field.
We investigated clinical pharmacists' interventions in the ICU from June 2013 to December 2014 (excluding the term from February 2014 to March 2014), and constructed a categorization by referring to the pharmaceutical interview form (IF). We configured “the necessity for the drug therapy” in addition to IF categories, because there were several inquiries by the pharmacists as to whether the medication should be started or discontinued. Then we classified clinical pharmacists' interventions from February 2016 to November 2016 using that categorization. During that period, there were 840 cases, and the most common category was “the necessity for drug therapy” which numbered 191 cases. Therefore, of all the cases there were 412 cases labeled “preavoid” in which the interventions improved the safety of the medication..
In this study, it was revealed that intervention by the clinical pharmacists positively identified the necessity for drug therapy. It seems that the clinical pharmacists require the ability to comprehend clinical conditions and evaluate drug therapies. An evaluation of “preavoid” cases using the categorization suggests pharmacists contribute to improvements in the quality and the safety of medication.