Benzodiazepines (BZDs) are frequently used for insomnia, but the long-term use of BZDs is associated with adverse events such as dependence and withdrawal syndrome. Suvorexant (SUV), an orexin receptor antagonist, is a novel hypnotic drug that has been shown to be effective for subjective measures of sleep onset and maintenance, safe, and well tolerated in clinical trials. In a long-term clinical trial, SUV discontinuation did not cause rebound insomnia or withdrawal symptoms, suggesting that it may be useful as an alternative drug in long-term users of BZDs. We retrospectively investigated the prescriptions when SUV was introduced to long-term users of BZDs. Sixty patients of long-term users of BZDs, who were prescribed SUV during January 2015 to December 2017, were analyzed. These patients were divided into the add-on group (n = 28) and the switching group (n = 32). The rate of SUV prescription continuation was 92.9％ in the add-on group, which was significantly higher (P = 0.048) than 71.9％ in the switching group. The all adverse events rate was 32.1％ in the add-on group and 28.1％ in the switching group, and there was no significant difference between the two groups. This study revealed that in long-term users of BZDs, add-on and switching were equivalently selected as the method of introducing SUV. It was also suggested that the rate of SUV prescription continuation could be maintained higher in the add-on group than in the switching group.

Excellent medication adherence to direct oral anticoagulants (DOAC) is crucial for the prognostic improvement of patients with non-valvular atrial fibrillation (NVAF). However, the level of medication adherence to DOAC and factors affecting medication adherence are not fully understood in Japanese patients in real-world clinical practice.

To assess medication adherence, this study enrolled 817 NVAF outpatients who took DOAC in 16 hospitals. Hospital pharmacists investigated the medication adherence by pill count and evaluated the patients’ knowledge about disease and medication.

The percentage of prescribed pills taken was 97.49 ± 6.728％, indicating an excellent medication adherence to DOAC. The proportion of non-adherence patients by definition 1 (percentage of prescribed pills taken < 90％ or no visit by the day after reaching the prescription days) was 8.9％ and that by definition 2 (definition 1 + did not bring unconsumed drugs) was 19.3％. Regarding the levels of patients’ knowledge about disease and medication, approximately 20％ of patients had no awareness of NVAF and 30％ of patients did not understand the purpose of their medication. Additionally, several factors associated with non-adherence were identified by the multivariate binary logistic regression analysis. A common factor between the non-adherence by definition 1 and definition 2 was the low level of knowledge about medication．

This study demonstrated that Japanese NVAF patients who were taking DOAC had excellent adherence. However, it is suggested that pharmacists strengthen the intervention especially for patients with a low level of medication knowledge, which may lead to further improvement of medication adherence to DOAC.

Medication notebook is an important information tool for patients and healthcare providers, but the description formats have not been standardized. As standardization of the prescription formats for the medication, the Ministry of Health, Labor and Welfare has recommended that the drug dosage should be described as “amounts-per-dose” instead of “amounts-per-day,” or both. However, it is reported that only 14％ of institutions describe both in the prescription. We surveyed the current status of the description formats in medication notebook at 288 institutions (16 hospitals, 15 clinics, 257 pharmacies), of 332 patients admitted to the University of Tsukuba Hospital. The percentage described on the “amounts-per-day” is 78.1％, “amounts-per-dose,” 6.9％, and both, 15.3％. The results suggest that the “amounts-per-dose” description is not commonly used. Since differences in description formats of medication notebook may cause communication errors in the users such as patients and healthcare providers, it is important to standardize the description formats of medication notebook as well as those of prescriptions.

Cabazitaxel (CBZ), used for castration-resistant prostate cancer, has a high frequency of severe myelosuppression. Pegfilgrastim is administered to prevent febrile neutropenia (FN);however, it may still occur, and in many cases, the CBZ dose is reduced for safety considerations. Therefore, a retrospective survey was conducted to investigate the impact of the initial CBZ dose of 25 mg/m² on the myelosuppression status, relative dose intensity (RDI), prostate-specific antigen (PSA) response rate, treatment duration , and overall survival (OS) in Japanese patients.

In the 25 mg/m² group, 6 patients had neutropenia higher than grade 3 (100％) and 1 patient had FN. There were 26 patients in the reduced-dose group, and neutropenia of ≥ grade 3 was observed in 5 patients (19％). The frequency of neutropenia was significantly higher in patients aged ≥ 74 years (P = 0.017). The 25 mg/m² group had significantly higher RDI (median: 96％ vs 67％, P = 0.016) and PSA response rate (50％ vs 19％, P = 0.043) than the reduced-dose group. In contrast, there was no difference between the two groups in terms of treatment duration (median: 5.9 vs 3.3 months, P = 0.220) and OS (median: 10 vs 13.5 months, P = 0.552).

The risk of developing ≥ grade 3 neutropenia was low, and no impact on the OS was observed in the reduced-dose CBZ group. It is recommended to reduce the initial dose of CBZ from 25 mg/m² to 20 mg/m² in Japanese patients.

This study clarifies the utility of guidance on the original nutrition table provided to patients undergoing monotherapy with oral anticancer agents. A satisfaction survey, using a questionnaire, was conducted. Nutritional indicators (weight loss and albumin) and the treatment completion rate were compared for the patients receiving S-1 adjuvant chemotherapy at Ogaki Municipal Hospital before (from February 2017 to February 2018, 68 cases) and after (from March 2018 to August 2019, 37 cases) the creation of the original nutrition table. 83.0％ (83/100) of the patients had a high overall satisfaction with the nutrition table, but 27.0％ (27/100) wanted to know more about the nutritional ingredients. Although the number of patients with weight loss decreased after the creation of the table (12/37 cases; 32.4％) compared to before (35/68 cases; 51.5％), this finding was not significant (P = 0.07). The treatment completion rates also improved after the creation of the table (30/37, 97.3％) compared to before (44/68, 64.7％); however, this was statistically insignificant (P = 0.12). The satisfaction with the nutrition table prepared this time was high, suggesting that it may lead to the continuation of cancer chemotherapy.

Hydrophilic petrolatum and heparinoid ointments which contain 3％ acetic acid (acetic acid-petrolatum and acetic acid-heparinoid, respectively) are used as hospital preparations for the topical treatment of skin infection. In this study, the storage stabilities of these preparations were investigated. The extent of acetic acid volatilization from both preparations was evaluated for eight weeks. The amount of acetic acid volatilized from both preparations increased over time even when stored in containers with a lid. When stored in containers without it, acetic acid volatilized more significantly than when stored with it. In acetic acid-petrolatum, the amount of volatilized acetic acid was increased as the storage temperature increased. Meanwhile, in acetic acid-heparinoid, the amount was increased in the order of 25℃ < 5℃ < 40℃. In addition, different patterns of volatilization were shown between the preparations, suggesting that the mechanism of volatilization from the preparations may be different. It was also shown that the content of acetic acid especially in the upper part of acetic acid-petrolatum decreased when stored in containers with a lid. In contrast, no difference in the content was observed between the upper, middle and lower parts of acetic acid-heparinoid. Taking these results and the model analysis data for drug release into account, it is suggested that in acetic acid-petrolatum, acetic acid gradually volatilizes from the surface through the diffusion process, whereas in acetic acid-heparinoid, acetic acid volatilizes from the whole parts without the diffusion process. These data are useful for promoting the proper use of these preparations and for developing more stable formulations.