In an effort to promote self-medication in Japan, drugs switched from prescription to over-the-counter (OTC) have received a lot of attention. We conducted a survey of community pharmacists to investigate views on Rx (Prescription) -to-OTC switched drugs, aiming at the enhancement of self-medication and proposals to the Regulatory Authorities. A total of 336 respondents completed the survey.
About two-thirds of respondents (65.2％) regarded the expansion of Rx-to-OTC drugs as necessary. The percentage of pharmacists who responded that Rx-to-OTC expansion was necessary at pharmacies for prescription and OTC drugs (73.2％) was significantly higher than those at pharmacies for prescription drugs (51.2％) (P < 0.001). The most common reason for Rx-to-OTC expansion being necessary was “it has a certain level of effect on reducing healthcare costs”. On the other hand, the most common reason against Rx-to-OTC expansion was “it causes safety issues for consumers”.
The number of candidates for Rx-to-OTC recommended by pharmacists in favor of Rx-to-OTC expansion was 43 with 14 therapeutic areas excluding 5 drugs accepted as Rx-to-OTC switched drugs by the Ministry of Health, Labour and Welfare. Six out of 43 candidate drugs are considered to meet the requirements for Rx-to-OTC drugs.
We revealed some differences in pharmacists' views on Rx-to-OTC switched drugs depending on the pharmacy category. To promote self-medication, constructing a mechanism to collect opinions of community pharmacists providing OTC drugs is required. Further research in other areas and pharmacies of different categories to confirm generalizability should be done for making a proposal to the Regulatory Authorities.
Due to its interaction with many anticancer drugs, warfarin has a diverse mechanism of action, such as inhibition of cytochrome P450 (CYP) 2C9, protein binding replacement, lower absorption of vitamin K due to gut toxicity, and so forth. We experienced a case in which sunitinib, a molecular-targeted agent, was administered while undergoing warfarin, and the international normalized ratio of prothrombin time (PT-INR) increased remarkably. Here, we investigate the pharmacological mechanism of PT-INR increase in this patient both experimentally and in the literature. A 67-year-old man was stable with PT-INR (2.0-2.3) using warfarin for anticoagulation. A cancerous pleural effusion from renal cell carcinoma was observed, and sunitinib was started. Immediately after taking sunitinib, warfarin was reduced because PT-INR was elevated, but PT-INR increased further to 6.12 on Day 10 after sunitinib initiation. In in vitro experiments, sunitinib did not inhibit CYP2C9 at clinical concentrations. In this patient, sunitinib concentration was not changed under warfarin combination. Sunitinib shows a protein binding rate of < 95％, and since he had hypoalbuminemia, protein binding substitution may induce an increase in unbound warfarin. However, from the viewpoint of plasma concentrations of both drugs, protein binding substitution could not contribute to this interaction. It also suggests the contribution of insufficient intake and absorption of vitamin K owing to sunitinib-induced anorexia and gastrointestinal disturbances. Furthermore, the contribution of disseminated intravascular coagulation was indicated, as the D-dimer was high. Despite this case, careful monitoring of PT-INR is necessary when sunitinib and warfarin are combined, as the mechanism is not fully understood.
This study investigated the efficacy of ceftriaxone (CTRX) for the treatment of aspiration pneumonia. We compared patients treated with CTRX versus sulbactam/ampicillin (SBT/ABPC). One-to-one propensity score matching was performed to compare the success rates of antibiotic therapy and in-hospital mortality between the groups. Moreover, the duration of antibiotic use, hospital period, and total antibiotic costs were compared among effective patients in the groups. There were 43 and 20 patients in the SBT/ABPC and CTRX groups, respectively. The propensity score matching included 20 patients in each group. There was no significant difference in the success rate of antibiotic therapy (85％ vs 95％, P = 0.62) or in-hospital mortality (25％ vs 5.0％, P = 0.22) between the groups. In addition, there was no significant difference in the duration of antibiotic use (median: 9 days vs 10 days, P = 0.94) or hospitalization period (median: 19 days vs 18 days, P = 0.94) among the effective patients in the groups. However, the total antibiotic costs were significantly lower in the CTRX effective group than the SBT/ABPC effective group (13,731 ± 4,903 yen vs 20.772 ± 6,840 yen, P = 0.001). CTRX may be another choice for antibiotic treatment for patients with aspiration pneumonia when they have no risk of drug-resistant bacteria.
This study investigated retrospectively the association between dexamethasone dose and skin toxicity elicited by docetaxel plus cyclophosphamide (TC) therapy in patients with breast cancer.
Twenty-three patients receiving TC therapy from October 2011 to June 2016 were assessed in Kyoto Kuramaguchi Medical Center. The onset of skin toxicity was observed in 14 patients (60.8％), including maculopapular rash (13.0％), urticaria (26.1％), and hand-foot syndrome (21.7％). In addition, most skin toxicity (85.8％) appeared in the first and second course of TC therapy, and their sites were variable.
Patients were classified into the no skin toxicity group (9 cases) and the skin toxicity group (14 cases). No significant difference was observed in the allergic history, the use of anti-allergenics as preventive agents , and the time of the year (winter administration). On the other hand, the optimal cutoff value of total dose/course of dexamethasone influencing skin toxicity was 18.6 mg/course by the Receiver Operating Characteristic curve. In no more than 18.6 mg/course of dexamethasone, eight of nine patients showed the onset of skin toxicity, whereas six of fourteen patients with greater than 18.6 mg/course of dexamethasone developed the skin toxicity (P = 0.040). The severities of skin toxicity also decreased in the use of greater than 18.6 mg/course of dexamethasone (P = 0.045).
Collectively, the onset of skin toxicity and their severities were associated with the total dose of dexamethasone per course, suggesting that the use of dexamethasone at greater than 18.6 mg per a course may prevent the skin toxicity.
Maintaining the oral cavity function is important in the intake of medicine and for the effectiveness of the medication itself. However, little is known about the need for medical, dental and pharmacological cooperation. We conducted a questionnaire survey related to side effects in the oral cavity in community pharmacies (n = 272) near our hospital belonging to the Pharmaceutical Association. We obtained responses from 120 pharmacies (44.1％). We also obtained comments from some dentists and a dental hygienist about the responses.
From the survey results, 75％, 60％ and 40％ of pharmacies have experienced consultation from patients concerning deglutition, dry mouth and gingival hyperplasia, respectively. It was revealed that a lot of pharmacies are consulted by patients about side effects in the oral cavity.
Eighty percent of pharmacies alerted patients to bisphosphonate-related osteonecrosis of the jaw. However, many pharmacists were concerned that they didn't know the initial symptoms and when bisphosphonate should be discontinued prior to dental treatment. These dentists commented that it would be better for the patients to consult with a dentist whenever the patients felt discomfort in their oral cavity.
In this study, it became clear that pharmacists and dentists need to exchange information and cooperate with each other. Community pharmacists can contribute to appropriate pharmacotherapy by preventing serious adverse effects using the knowledge of oral cavity medications, because patients first consult the pharmacists regarding the medication.
Urine containing anticancer drugs may be scattered outside the toilet bowl during urination, and these drugs may be spread when they are stepped on. The scattering of urine droplets is dependent on the shape of the toilet bowl, contact point of the urine with the toilet bowl, and the posture assumed for urination. However, this concept has not been well investigated. In this study, we investigated the scattering of urine using fluorescent dye in a urinal and a Western-style toilet.
To represent urination in the standing position, we sprayed a fluorescein solution on the wall or the bottom of a urinal. We modeled urination in the standing and sitting positions in a Western-style toilet by spraying fluorescein into the toilet bowl and in three spots around the toilet bowl. The number of droplets, area, scattering distance, and scattering area around the toilet bowl were measured optically.
The droplet scattering was more extensive around the toilet bowl when the liquid was aimed at the bottom of the urinal and the front edge bottom of the water in the Western-style toilet. There was no droplet scattering when using the Western-style toilet in the sitting position.
If a male patient receiving chemotherapy urinates in the standing position, the anticancer drug will spread through scattered urine and become an environmental pollutant. Therefore, it is important to instruct male patients to urinate in a sitting position when using a Western-style toilet.
Pegfilgrastim (PEG-G) is recommended as a primary prophylactic treatment agent to prevent febrile neutropenia (FN) in regimens with a known 20％ FN occurrence rate. While the prevention of FN by PEG-G is evident in short-term chemotherapy regimens, the effect of PEG-G in long-term daily regimens such as docetaxel, cisplatin, and 5-fluorouracil (DCF) for esophageal cancer is unclear. Therefore, we examined retrospectively the effect of PEG-G (as primary prophylactic treatment) on FN occurrence in patients with DCF therapy. The results were 6 cases (40.0％) of FN occurrence in the PEG-G group and 10 cases (43.5％) in the Non-PEG-G group. Additionally, no significant difference was observed in the occurrence of Grade 4 neutropenia between the PEG-G (7 cases, 46.7％) and Non-PEG-G (15 cases, 65.2％) groups. Based on the above data, primary prophylactic treatment with PEG-G did not prevent FN occurrence in esophageal cancer patients with DCF therapy. It has been reported that the neutrophil nadir of docetaxel is Day 8, suggesting the possibility that the PEG-G administration period needs to be considered.
Pharmacists are expected to help reduce increasing healthcare costs. This study assessed the effects of pharmacists at community pharmacies checking for unused prescribed medications using a bag in which patients put medications (Setsuyaku Bag). We examined whether this check improved medication adherence and also measured the costs of the unused medications.
Patients aged ≥ 20 years who brought the bag to community pharmacies were followed-up for 6 months. They took the bag to pharmacies if they had unused medications including those recently prescribed. Medication adherence scores at the first visit and after 6 months were assessed by patients (good 0–bad 4) and by pharmacists (good 1–bad 4). Changes in scores were analyzed using paired t-tests. Costs of unused medications were calculated, grouped as reused, saved, or discarded.
The patient adherence score for 73 patients (mean age 71.3 years) decreased from a mean of 1.8, SE 0.1 at the first visit to 0.8, 0.1 at the 6-month visit (P < 0.001). The pharmacist adherence score also decreased over this period from a mean of 2.4, SE 0.1 to 1.5, 0.8 (P < 0.001). The mean cost of total unused medications during the 6-month per person was 9,962 yen: reused 6,523 yen (65.5％), saved 1,506 yen (15.1％), and discarded 1,933 yen (19.4％).
Pharmacists' checkup for unused medications using a Setsuyaku Bag was likely to be effective for improving medication adherence, indicating that pharmacists can contribute indirectly to reducing healthcare costs through medication adherence and directly by lowering medication costs.