The associations between polypharmacy, potentially inappropriate medications' (PIMs) use or anticholinergic load, and rehabilitation outcomes in Japan are unclear. This review evaluated whether polypharmacy, PIMs' use, or anticholinergic load during hospitalization affected the basic activities of daily living (ADL) Functional Independence Measure (FIM) among geriatric patients with stroke in a convalescent setting. First, we evaluated 144 consecutive geriatric stroke patients with chronic kidney disease to establish the association between polypharmacy and FIM-motor (FIM-M). Multiple logistic regression analysis for polypharmacy, adjusting for confounding factors, revealed that polypharmacy was independently and negatively correlated with FIM-M efficiency. Second, we evaluated 272 consecutive geriatric patients with stroke with low ADL to establish the association between PIMs' use and FIM-M. Multiple linear regression analysis for FIM-M gain, adjusting for confounding factors, revealed that increased PIMs' use was independently and negatively correlated with FIM-M gain. Finally, we aimed to establish whether anticholinergic load was associated with FIM-cognitive (FIM-C) among 418 geriatric patients convalescing after stroke. Multiple linear regression analysis for FIM-C gain, adjusting for confounding factors, revealed that increased anticholinergic load during hospitalization was independently and negatively correlated with FIM-C gain. These results may be useful to ensure the proper use of drugs in the convalescent setting.

Patients with cancer often report a lower quality of life due to neuropathic pain, which is difficult to manage because resistance to opioids often develops. Pregabalin (PGB) is recommended as an adjuvant analgesic for neuropathic cancer-related pain; however, PGB administration is currently limited to the oral route. We examined the pharmaceutical properties of a PGB hollow-type suppository for hospital use and assessed bioequivalence through examination of the pharmacokinetic parameters in rabbits.

The suppositories were prepared using melting (m-) and hollow (h-) methods with bases of polyethylene glycol (P), Witepsol H-15 (H), or Witepsol S-55 (S), yielding the following combinations: m-P, m-H, m-S, h-P, h-H, and h-S. Pharmaceutical properties, namely hardness, dispersibility, long-term stability, and drug release, were measured for each combination and were compared for orally administered (po) drugs and hollow-type suppositories.

Sufficient hardness was demonstrated for all h-suppositories compared with m-suppositories. The release rate of PGB was higher from h-suppositories than from m-suppositories, particularly the h-S group, and bioavailability was similar in the h-S and po groups. The h-S group exhibited significant pathological changes compared with the h-H group. To reduce injury from the repeated administration of suppositories, an S:H blending ratio of 1:1 significantly reduced the pathological changes.

Hollow-type suppositories may be useful as they are pharmaceutically stable and, when used with an S-base, able to deliver the same effects as orally administered drugs. The suppository was shown to be effective and is a promising clinical treatment owing to the enhanced convenience when used in hospitals.

The expansion of new anti-cancer drug options against unresectable non-small cell lung cancer (NSCLC) is remarkable. On the other hand, the cost rise of these medicines has also risen sharply. In this study, we compare drug cost before and after approval of very expensive Pemetrexed (PEM) and Bevacizumab (BV) and its effect on NSCLC and investigate cost effectiveness.

Patients who took Cisplatin or Carboplatin as 1st line therapy for NSCLC at Shizuoka Prefectural General Hospital were divided into two groups, and the cost for chemotherapy (Cost) and survival period (OS) were investigated. The two groups are the PEM · BV (-) group, which started treatment from July 2006 to June 2007 and the PEM · BV (+) group, which started treatment from January to December 2011.

The PEM · BV (-) group includes 39 patients (adenocarcinoma (AC): 22, squamous cell carcinoma (SCC): 12, others: 4), and the PEM · BV (+) group includes 47 patients (AC: 29, SCC: 12, others: 4). The cost median is 1,002,000 yen (115,000 - 6, 304,000) in the PEM · BV (-) group, and 1,416,000 yen (107,000 - 15,798,000) in the PEM · BV (+) group, the OS median is 325 days (25 - 1,460) in the PEM · BV (-) group and 378 days (8 - 1,460) in the PEM · BV (+) group.

Although the cost of cancer chemotherapy has increased due to highly expensive new anticancer drugs, there was no prolongation of OS. This suggests that the drug price setting of new high-value anticancer drugs and their appropriate use should be reconsidered.

Since infusion reaction (IR) frequently occurs in rituximab (RTX) therapy, premedication of antipyretic analgesics and histamine 1 (H₁) receptor antagonists before RTX administration is essential. However, there are no standard drugs for H₁ receptor antagonists. There is a possibility that H₁ receptor antagonists with various pharmacokinetic properties have different preventive/suppressive effects against IR. In this study, we conducted a retrospective study on patients who received RTX first dose with premedication of fexofenadine (n = 31) or bepotastine (n = 33), the second generation H₁ receptor antagonist, to compare the inhibitory effects of both drugs on IR occurrence. The incidence of IR was 58.1％ in the fexofenadine-administered group and 21.2％ in the bepotastine-administered group with a significant difference. The IR occurrence time (median) was 65 min after RTX administration in both groups. Multivariate logistic regression analysis indicated that the fexofenadine-administered group is an independent risk factor to increase the risk of IR occurrence by 8.3 times compared with the bepotastine-administered group. Since fexofenadine takes a longer time to reach maximum blood concentration (T_max) than bepotastine, it is considered that the different effect on IR prevention in both drugs may be caused by the difference in T_max. Based on these results, it was suggested that H1 receptor antagonists to be administered before RTX administration should be selected taking their pharmacokinetic properties into consideration.

Warfarin (WF) has been used for the prevention and treatment of thromboembolism for a long time; however, its use in short bowel syndrome after jejunal and ileal resections has not been reported. We present a case report, which to the best of our knowledge, is the first regarding the treatment of short bowel syndrome after jejunal and ileal total resections using WF.

A 75-year-old man, hospitalized for stroke in 2015, developed an upper mesenteric arterial thrombosis a few days later and underwent resection of the small intestine from the Treitz ligament to the ileum and right colon. He developed cerebral infarction after surgery and was administered heparin sodium injection; however, owing to poor anticoagulation control, WF was added. The patient was administered 1,920 mL to 3,000 mL of ELNEOPA No. 1 injection containing 1,920 µg to 3,000 µg of vitamin K (VK). The WF dose was progressively increased to a daily dose of 10 mg, and the prothrombin time-international normalized ratio (PT-INR) was maintained at 1.5-2.5. The patient was transferred to another hospital on the 134^th day.

After initiation of WF, PT-INR was unmeasurable but PT was >180 min on the 16th day, while PT-INR was 6.39 during the dosing period on the 55th day. However, in either case, catheter-related bloodstream infection was suspected, and the central venous catheter was removed. Total parenteral nutrition was modified to peripheral parenteral nutrition. The antagonism of VK and WF was considered to have disappeared, and the PT-INR showed an increase.

A stapler-shaped tablet-splitting device is typically used to split tablets to reduce the total dose, and the precision of the division depends on the device and class of the drug. In this study, the precision and dispensing time of several splitting devices were compared. Five tablet-splitting devices were compared with tablet-cutting scissors using the following parameters: 1) weight error relative to the theoretical weight, coefficient of variation, and acceptance value based on the content uniformity test; 2) decrease in total weight; 3) frequency of unequal splitting with a weight error of more than 25％; and 4) splitting time. Five tablets with different properties were used in this study. Five pharmacists used each device to divide 10 tablets per drug and measured the weight before and after dividing the drug and the dispensing time. The weight error associated with tablet-cutting scissors (control device), was 12.0％ (median). In contrast, the weight error ranged from 6.5％ to 17.5％ for all other tablet-splitting devices. The decrease in total weight when tablet-cutting scissors were used was 0.3％, compared to a decrease of 0.4-11.8％ with the other splitting devices. The coefficients of variation and acceptance values obtained from the post-division weight were greater for all devices (13.1-24.7％ and 25-43). Except for one device, there was no difference in splitting time.

Tablet division can compromise uniformity even when a tablet-splitting device is used. Therefore, for drugs that are typically imprecisely split, the choice of splitting device at the time of tablet dispensing is important.

The bioavailability (BA) of commercially available fentanyl transdermal tape (CA-fentanyl tape) is enhanced under pyrexia. However, the contribution of drug release from the formulation and drug skin penetration in the enhanced BA has not yet been reported. In this study, we investigated the mechanism of drug penetration in CA-fentanyl tape by using a Franz diffusion cell set 0.45-μm membrane filter (drug release test) or rat abdominal skin (skin permeation test) at temperatures of 37℃ (normal) and 42℃ (hyperthermia). No difference in the drug release was observed between the 37℃ and 42℃ conditions, and the fentanyl in the formulation was completely released into the reservoir chamber at 9 h under both temperatures. Moreover, the amounts of fentanyl in the skin were also similar at 37℃ and 42℃. In contrast to the results in drug release and retention, the skin penetration at 42℃ was significantly higher than that at 37℃, and the area under the drug concentration-time curve (AUC_0-30) at 37℃ and 42℃ were 3.13 ± 0.03 µmol∙h/cm², 3.73 ± 0.14 µmol∙h/cm², respectively. In conclusion, we found that the drug release from CA-fentanyl tape was not changed, although skin permeation was enhanced under mild hyperthermia (42℃) resulting in the enhancement of BA. These results provide useful information for the application of CA-fentanyl tape in the clinical setting.