One of the issues facing mental health care delivery in Japan is the polypharmacy with antidepressants and anxiolytics. Investigating these prescriptions has not yet been fully performed. Herein, we investigated the prescription status of antidepressants and anxiolytics in our hospital from 1997 to 2018. Subjects included in this study were psychiatric outpatients. Prescription profiles, as well as doses for antidepressants and anxiolytics, were obtained from the patients’ medical charts. Subsequently, the prescription rates for antidepressant monotherapy and combination therapy increased and decreased, respectively. The prescription rate of treatment with a combination of antidepressant monotherapy and anxiolytics decreased. The prescription rate of anxiolytic with antidepressant combination therapy was higher than that of monotherapy. These prescribed antidepressant-related results suggest that appropriate use of psychotropic medications is encouraged to reduce concomitant in-hospital use.

Cooperation between community pharmacies and hospitals in the perioperative period is critical. This study used a questionnaire survey to examine the current status of pharmacists’ contributions to the perioperative period in Mie prefecture. The response rates were 100％ (32/32) for hospitals and 53％ (396/752) for community pharmacies. Approximately 78％ hospitals confirmed prescriptions of preoperative withdrawal drugs prior to surgery primarily for outpatient care. Hospital pharmacists shared information about withdrawal drugs with attending physicians, anesthesiologists, and nurses. While only 33.3％ of hospitals provided information to community pharmacies, 63％ of community pharmacies offered information to hospitals, thereby indicating an imbalance in information sharing between community pharmacies and hospitals. Although hospital pharmacists supplied information to community pharmacies using medication notebooks (62.5％), the tracing report (54％) was most common in community pharmacies, suggesting that it is important to create sharing tools using both the medication handbook and tracing report. Hospital pharmacists need details on response to withdrawal drugs (20％), the degree of patient and family understanding (20％), history of allergies (17.1％), status of taking supplement or over the counter drugs (14.3％), and resumption of withdrawal drugs after the operation (14.3％) from community pharmacies. Furthermore, community pharmacists must be aware of hospital regulations for the withdrawal period (14.6％), operation date (12.3％), and details of operation procedure (10.9％). Based on these results, it may be necessary to create a separate information sharing tool for preoperative and postoperative periods using the medication notebook and tracing report.

Favipiravir was started for compassionate use as a COVID-19 treatment. However, since the drug was used off-label, teratogenicity countermeasures were not implemented at the initiative of the pharmaceutical company. Therefore, we developed and implemented our own “Pregnancy Avoidance Follow-up Program” and conducted an observational study to examine its effectiveness.

The program subjects were women < 50 years of age and men of all ages. The contraceptive period was 90 days after administration, and along with the instruction to always use contraception, the men were instructed not to donate sperm. In addition to the pre-discharge interview, telephone interviews were conducted at 30, 60, and 90 days after completing the dose. Considering the time difference between fertilization and pregnancy detection, a 120-day follow-up was added for women.

The study period was from May 2020 to March 2021, and the number of subjects was 52. Although the subjects were informed of the contraceptive period before administration, the correct answer rate for the period in the pre-discharge interview was only 44％. The importance of re-instruction at discharge in patients with sudden infections was clarified. Furthermore, although no pregnancies occurred in this study, cases of contraceptive non-compliance were detected, which clearly shows the importance of the program.

To avoid repeating the well-known thalidomide disaster that occurred many years ago, it is desirable to implement pregnancy avoidance programs and measures that lead to the establishment of evidence of teratogenicity through national initiatives in the compassionate use of teratogenic drugs.

Among 2957 patients treated for coronavirus infection (COVID-19), 31 patients experienced hiccups during treatment. We investigated the backgrounds of these patients, and report the usefulness of steroid rotation from dexamethasone to prednisolone. These 31 cases of hiccups were observed only in men．Thirty of these patients received remdesivir and steroids during COVID-19 treatment, and 25 of the 31 received hiccups drug treatment alone. In 9 of 31 patients, hiccups persisted. On the other hand, all of the 6 patients who received steroid rotation experienced the improvement of hiccups. Hiccups disappeared within two days of steroid rotation. Thus, these findings suggest that steroid rotation is effective treatment in patients with hiccups who are undergoing COVID-19 therapy.

Prospective audit and feedback (PAF) by pharmacists is recommended for antimicrobial stewardship. We examined the effectiveness of PAF by pharmacists in reducing drug costs. PAF was provided to selected patients using specific antibiotics (eg, carbapenem, anti-MRSA drug, and tazobactam/piperacillin) in 2016 (before the expansion) and to all the patients using injectable antibiotics in 2017 (after the expansion), for a period of one year for each. The average reduction in the cost of monthly antibiotics and the estimated cost reductions per suggestion by pharmacists were compared before and after the expansion, respectively. We retrospectively compared the estimated drug cost (assuming that antibiotic therapy at the time of the prescription was continued for the actual administration duration) with the drug cost following the prescription suggestion. The estimated reduction in drug cost was calculated by subtracting the actual drug cost from the estimated drug cost. The mean decrease in the cost of specific antibiotics before and after the intervention was not significantly different (at -171,964 yen/month), but there was a significant reduction of 545,286 yen/month for non-specific antibiotics (P < 0.001). There were 190 pharmacist suggestions before and 607 after the expansion. The estimated cost reduction per suggestion by pharmacists was -2,526 yen before the expansion but significantly increased to 4,330 yen after the expansion (P = 0.034). The results suggest that continuous intervention in selected patients using specific antibiotics is unlikely to reduce drug costs, but the expansion of surveillance to include all the patients using injectable antibiotics may reduce drug costs.

The International Olympic Committee has released a consensus statement regarding supplements used by athletes (sports supplements: SSps), and it is expected that the number of athletes using SSps will increase. In 2021, the World Anti-Doping Agency introduced the “International Standard for Education” to promote a healthy sports competition environment. This study investigated the learning experience and knowledge of pharmacists regarding SSps to identify issues for learning in the promotion of anti-doping activities by pharmacists and to examine countermeasures. We conducted a web-based survey of 270 pharmacists in their 30s or older working at pharmacies and hospitals in the Kanto area. The 196 respondents working in pharmacies were divided into two groups: sports pharmacists (SPs) and non-SPs, and their experiences and confidence handling consultations were analyzed. All respondents were divided into two groups-those who had SPs, sports doctors, and sports nutritionists at their workplaces (enrolled group) and those who did not (non-enrolled group)-and their learning experiences and methods were analyzed. Of the 163 non-SPs, 42％ had been consulted by athletes, their families, or instructors about medicines or SSps, and one-third of these had been consulted about SSps. Among the various learning methods presented by both groups, “e-learning” was the most common tool and “academic societies” were the most common organizer of study sessions. Even pharmacists not involved with competitions, including non-SPs, were consulted about SSps, suggesting the need to learn about SSps. In terms of learning methods, it is desirable for specialist organizations to provide learning opportunities such as e-learning.

Direct oral anticoagulants (DOACs) exert their anticoagulant effects by directly inhibiting thrombin and factor Xa; however, it is important to consider the interactions of DOACs with concomitant medications as some medication may increase the risk of bleeding. Selective serotonin reuptake inhibitors (SSRIs) and serotonin noradrenaline reuptake inhibitors (SNRIs) have been reported to reduce platelet aggregation and increase the risk of bleeding. However, there is little evidence regarding the interaction between DOACs and SSRIs or SNRIs in Japanese patients. Therefore, the aim of our study was to investigate the background of bleeding in Japanese patients using SSRIs or SNRIs in combination with DOACs. Seventeen patients who took DOACs in combination with SSRIs or SNRIs between January 2016 and December 2019 at Kyoto University Hospital were included in the study. The observation period was 6 months after commencing DOAC administration and 6 months after of the commencement of SSRI or SNRI administration; moreover, the pre- and post-treatment examinations were performed to assess the changes for each patient. There was no incidence of major bleeding when only DOAC was used, but four of the seventeen patients (23.5％) had major bleeding when antidepressants were administered in addition to DOACs. Known bleeding risk factors such as hypertension, liver dysfunction, smoking history, cancer, peptic ulcer, and thrombocytopenia were not identified as risk factors for major bleeding in this study.