The first academic subcommittee of the Japanese Society of Pharmaceutical Health Care and Sciences has a plan to create a guide on how to manage drug interactions in clinical settings. This review describes the information that forms the basis of the guide. This article, part (1), reports the results of a questionnaire on the content of the guide and also describes how to evaluate and manage drug interactions in clinical settings. The contents of the ʻDrug Interaction Guideline for Drug Development and Labeling Recommendationsʼ, the new Japanese guideline, are also described. It is important also in clinical practice to appropriately evaluate and manage drug interactions based on a sufficient understanding of the new guideline and related information.

The first academic subcommittee of the Japanese Society of Pharmaceutical Health Care and Sciences has a plan to create a guide on how to manage drug interactions in clinical settings. This review describes the information that forms the basis of the guide. This article, part (2), summarizes the practice reports on managing drug interactions in clinical settings, their problems, and the proper concepts of drug interactions in patients with special background. Each pharmacist is expected to enhance the literacy of drug interactions and manage them adequately, which will lead to the improvement of clinical outcomes.

The first academic subcommittee of the Japanese Society of Pharmaceutical Health Care and Sciences has a plan to create a guide on how to manage drug interactions in clinical settings. This review describes the information that forms the basis of the guide. As evidence for drug interactions with various mechanisms has not been clarified for all combinations, each case needs to be managed based on knowledge of clinical pharmacology regarding drug interactions. This article, part (3), shows the examples of both experimental and surveillance studies on drug interactions and also summarizes the points that require consideration when conducting surveillance studies.

The focus on drug interactions based on polypharmacy is increasing given that the number of elderly people continues to increase in Japan. Pharmacists are expected to contribute to the proper use of drugs through the assessment and performance of wet and dry studies.

Compliance with hand hygiene is important in infection control, and the rate of hand disinfectant application is rising in recent years. Therefore, we evaluated the qualitative evaluation system of hand hygiene by mechanically measuring hand disinfectants containing a fluorescence substance. We observed that the hospital staff and general population had a significantly higher application rate of hand disinfectant on the palm side than on the dorsal side (P < 0.05). Hospital staff had a significantly higher application rate compared to the general population (P < 0.05). Disinfectants on the bad hand hygiene area are distributed more on the dorsal side than on the palm side in both hospital staff and general population. Particularly, the bad hand hygiene area was around the thumb of both hands. Disinfectant distribution on the bad hand hygiene area was evaluated by GlitterBug, particularly on the fingertips, which was different from the evaluation using HandInScan. It was estimated that disinfectant distribution on the bad hand hygiene area is associated with hand hygiene techniques, amount of hand disinfectant applied, and other factors. Therefore, evaluation and appropriate instruction on hand hygiene methods is necessary. HandInScan and GlitterBug both had advantages, therefore it seemed useful to choose them as appropriate. In addition, the involvement of pharmacists in the evaluation of such systems is meaningful for contributing to more effective and appropriate use of hand disinfectants.

Recently, drug vial optimization (DVO) for anti-cancer drugs has been recommended as one of the concrete measures to decrease medical costs. DVO enables us to use single-dose vials for more than one patient to minimize unused drug waste to save on medical costs. Multiple needle punctures of the rubber stopper of the vial, however, could potentially increase the leakage of anti-cancer drugs raising concerns for worker exposure risk during the dose formulation preparation. Thus, we evaluated the relationship between the preparation procedure and leakage of anti-cancer drugs to determine an adequate preparation procedure for multiple use with a low risk of worker exposure.

No significant increase in leakage of anti-cancer drugs was observed with the adequate preparation procedure following the preparation manual of each anti-cancer drug together with replacing the device between preparation intervals for multiple use, irrespective of the presence or absence of a closed system drug transfer device (CSTD). In contrast, the preparation procedure with deviations from the preparation manual resulted in a significant increase in drug leakage. These results indicate that CSTD is not mandatory to reduce the risk of worker exposure during the preparation for multiple use although it has been generally recommended. To perform the adequate preparation for multiple use without CSTD, however, replacing the syringe and needle for every single preparation should be mandatory in addition to adequate procedures consistent with the preparation manual such as creating a slight negative pressure and adequate needle puncture (including adequate location and direction).

A simple spectrophotometric assay was developed for quantitative determination of selenium in selenium injection which is a hospital preparation for patients with selenium deficiency. Aliquots of the samples (500 µL) added 20 µL of 2.5 M formic acid and 20 µL of 18.5 mM O-phenylene diamine were incubated for two hours at room temperature. The absorbance was measured in the mixture at 333 nm by using NanoDrop^®, a convenient instrument for spectrophotometric assay. The standard curve for determining selenium concentration was linear in the range of 1.25-30 µg/mL (r > 0.999). Coefficients of variation for intra- and inter-day assays were 0.3 to 5.5％ and 0.8 to 2.8％, respectively. Assay validation was confirmed by five independent measurements of 50 µg/mL selenium injection in three pharmacists with the accuracy of 0.0 to 1.6％. This assay method was successfully applied to the quantitative determination of selenium in selenium injection.