Hypoglycemia is an acute complication of diabetes mellitus. In severe cases, it may lead to impaired consciousness, and glucagon nasal powder plays an important role as an emergency treatment. However, there have been no reports of pharmacist interventions using glucagon nasal powder. Therefore, we established a pharmacotherapy management-based protocol to prescribe glucagon nasal powder in educational hospitalization in patients with diabetes, and evaluated its efficacy by a questionnaire survey. According to this protocol, the pharmacist plays a central role in providing education about hypoglycemia and offering glucagon nasal powder to patients based on agreement with the attending physician. During the first year after its introduction, 31 patients received glucagon nasal powder following this protocol. The questionnaire survey revealed that patients who received glucagon nasal powder had a better understanding than patients who did not. Furthermore, 60% of the patients stated that glucagon nasal powder reduced their hypoglycemia anxiety. The present study showed that glucagon nasal powder may be advantageous for reducing hypoglycemia anxiety, and this protocol has the potential to improve the understanding of hypoglycemia. Therefore, this protocol could contribute to improved adherence.
The revised TDM Clinical Practice Guidelines for Antibiotics published in February, 2022 recommend administering a loading dose of vancomycin (VCM) to patients with renal impairment (eGFR <80 (mL/min/1.73m2)). Herein, we investigated the efficacy and safety of administering a loading dose of VCM to our patients with an eGFR <80 compared with those with an eGFR ≥80. The nomogram of our hospital specifies VCM loading doses of 1 g and 1.5 g for body weights <55 kg and ≥55 kg, respectively. The maintenance dose was set to a fixed value for each creatinine clearance value (mL/min). Renal dysfunction was not detected in the eGFR <80 group (n = 59) compared with an incidence of 9.0% in the eGFR ≥80 group (n = 11). The incidence of acute kidney injury did not significantly differ between groups (8.4%, eGFR <80 group; 9.0%, eGFR ≥80 group). The average value of the initial VCM trough concentrations did not significantly differ between groups (10.8 ± 4.1 μg/mL, eGFR <80 group; 10.6 ± 3.8 μg/mL, eGFR ≥80 group). These results indicate that administering a loading dose of VCM to patients with renal impairment (eGFR <80) is safe. The loading dose may be appropriate in this study.