Drug safety is frequently reported by several mass media outlets, and most medical professionals consult patients based on these media reports. Meanwhile, medical professionals are only aware of patients who have opted for “consultation,” and there may be many patients who have potential anxiety but have not consulted medical professionals. Therefore, this questionnaire survey aimed to clarify the impact of such media reports from the patients’ perspective. In this study, we targeted two populations: patients who responded to a questionnaire panel registered with an Internet research company (Internet panel), and patients who visited community pharmacies. On the Internet panel, a preliminary survey was conducted to identify those who experienced anxiety due to mass media reports, and then a main survey was conducted to collect more details. Of the 3,825 patients who responded to the Internet panel in the preliminary survey, 1,137 (29.7％) had experienced anxiety after receiving drug-related information from mass media. Of these, 525 participated in the main survey. In the survey conducted at community pharmacies, 109 of the 254 respondents (42.9％) experienced anxiety. In both surveys, approximately half of the respondents had never consulted others (such as medical care professionals) regarding their anxieties. Among the respondents who experienced anxiety, 127 (24.2％) and 13 (12.0％) had self-adjusted their doses or discontinued medications, respectively, because of anxiety caused by mass media reports. These results suggest that mass media reports may interfere with appropriate drug therapy.

Electronic medical records register patients with drug allergies and display an alert when the medication is prescribed. Information such as the code for the pharmaceutical must be properly registered for the alert to be displayed; otherwise, the alert may not function and the prescription may be missed. A manual fully instructed users on registering a drug allergy but ensuring proper registration is difficult and remedying improper registration is an issue. To rectify improper registration, a written alert was displayed when a drug allergy was registered, and proper registration improved from 44.4％ to 55.4％. Nevertheless, improper registrations were occasionally noted despite the alert, and further improvements are required. Therefore, this study comprehensively identified registered drug allergies and created a system wherein pharmacists check all registrations and correct the improper ones. Consequently, 19.9％ of the improperly registered drug allergies were corrected, and proper registrations increased to 81.3％. The corrected registrations included medication that could cause serious symptoms such as anaphylaxis, and the displayed alerts may have prevented incorrect administration. Checking and correcting every registration required an average of 10.6 min/day. After the system was implemented, there were no instances of incorrect drug administration to patients with a history of allergies due to improper registration, and the system presumably helped with the proper registration of drug allergies and avoiding adverse drug reactions. In addition, many medical facilities can consider introducing this system without significantly increasing the workload of pharmacists. This system is useful for ensuring patient safety.

We report a case of suspected PT-INR prolongation due to concomitant use of warfarin and ketoconazole cream. The patient had squamous cell carcinoma of the lung and was being treated with chemotherapy. Moreover, the patient developed mitral regurgitation (after mechanical mitral valve surgery) and continued to use warfarin. During the course of treatment, the patient was diagnosed with tinea pedis and ketoconazole cream was prescribed. When the patient came to the hospital for chemotherapy, a blood sample was obtained, which showed a prolonged PT-INR of 3.69. Ketoconazole cream and cefaclor were the only additional medications administered during the 6-month period, and a drug interaction between ketoconazole cream and warfarin was suspected. The patient was itchy and scratched, and the wounds were relatively extensive. As a result, ketoconazole cream was absorbed from the wound and entered the systemic circulation in small amounts, possibly causing a drug interaction with warfarin, resulting in prolonged PT-INR. To the best of our knowledge, there have been no reports of drug interactions between topical ketoconazole and warfarin. Although topical medicines are generally considered unlikely to cause drug interactions, caution should be exercised depending on the patient’s condition. When considering drug interactions, the patient’s condition should always be monitored along with medicines.

We report a case of a male patient in his 50s who contracted COVID-19 and experienced seizures and altered consciousness after receiving nirmatrelvir/ritonavir. Various antiviral drugs have been developed and used for the treatment of COVID-19. Among these, nirmatrelvir/ritonavir has been widely used, based on data from comparative trials against placebos.

The patient was regularly administered clozapine for the management of schizophrenia. Upon developing COVID-19, nirmatrelvir/ritonavir was initiated. Two days after initiation, the patient exhibited seizures and altered consciousness, leading to hospitalization. The blood concentrations of clozapine were measured upon admission, and despite several days of discontinuation, they remained within the therapeutic range. There is a possibility that the blood concentration was elevated during the onset of seizures and impaired consciousness, although the medication was paused. Following admission, as the blood concentration decreased, there was an improvement in seizures and impaired consciousness.

This suggests a potential interaction between nirmatrelvir/ritonavir and clozapine, leading to an elevation in clozapine blood levels and subsequent seizures and altered consciousness.

We investigated the influence of pharmacists’ efforts to taper and discontinue treatment with benzodiazepine receptor agonists (BZs) in hospitalized patients who could communicate and expected ≥14 days of hospitalization at a nonpsychiatric hospital (February 25, 2021 – February 24, 2022). Patients on psychiatrically prescribed BZs were excluded. A predesigned physician consent protocol for tapering or discontinuing the BZ treatment was established. After obtaining patient consent, we proposed a prescription according to this protocol to the patients’ attending physicians while repeatedly monitoring the patients’ sleep status. The outcome measures were the percentage of patients achieving BZ tapering or withdrawal, the diazepam-equivalent dose, the patients’ sleep quality per the Athens Insomnia Scale (AIS), and adverse effects (AEs). A total of 14 patients were enrolled (5 males, 9 females; median age 80.5 years), 13 of whom were followed up. Ten patients (77％) reduced or discontinued BZ intake. The median diazepam-equivalent significantly decreased from 3.75 mg/day to 2 mg/day (P < 0.05). The mean AIS score improved from 6.7 (suspected insomnia) to 4.6 (suspected mild insomnia) (P = 0.08). The percentage of patients experiencing anxiety and transient forgetfulness decreased from 90％ to 50％ (P = 0.14) and 40％ to 0％ (P = 0.09), respectively. The change in sleep quality and the incidence of AEs were not significant, but the clinical significance of these parameters is important. Our results suggest that pharmacist support in the inpatient setting can lead to a reduction or discontinuation of BZ medications, which may improve patients’ sleep quality and reduce AEs.

In recent years, pharmacists have undertaken various responsibilities such as pharmacological management in hospital wards. One strategy that aimed to optimize working time to enhance pharmaceutical management involves delegating certain aspects of a pharmacist’s tasks to non-pharmacists. Although medical supply processing and distribution (SPD) has gained attention as a drug inventory management system, the effect of implementing medical SPD on pharmacists’ working hours has not been analyzed. Therefore, this study aimed to analyze the effects of implementing medical SPD on ward activities of pharmacists and the number of drug management guidance cases conducted by ward pharmacists. Time-series data from April 2020, before the implementation of medical SPD, to March 2023, two years after its implementation at Yamaguchi University Hospital, were analyzed using an interrupted time-series segmented regression analysis. Following medical SPD implementation, there were significant increases in working time within a ward and the number of drug management guidance cases by 9 hours per month per ward pharmacist (P = 0.019) and 8.8 cases per month per ward pharmacist (P = 0.022), respectively. However, the implementation of medical SPD did not significantly affect the trend in working time within a ward or the number of cases of drug management guidance. Moreover, the total costs of discarded drugs decreased by 16.8% after the implementation of the medical SPD compared to the pre-implementation period. These results imply that the implementation of medical SPD contributes to the optimization of ward activities of pharmacists and increases the number of drug management guidance cases conducted by ward pharmacists.

Kurashiki Central Hospital provides communication skills training for junior pharmacists provided by a clinical psychologist. To improve the training content, we used a questionnaire to assess junior pharmacists’ knowledge and skills in communication techniques. The questionnaire was administered before training. Junior pharmacists rated their communication skills and behaviors in providing medication instructions to patients on a 10- and 5-point scales, respectively. Younger pharmacists tended to have knowledge of communication techniques that they considered important, select programs taken during their undergraduate education as a source of knowledge, and retain the communication skills acquired as students. Communication skills that were considered important by a higher percentage of pharmacists with fewer years of experience were “asking closed questions” (P = 0.007), “nodding” (P = 0.019), “giving responses” (P = 0.014), and “affirming the patient’s feelings” (P = 0.016). All trainees wanted to focus on points that would encourage patients to change their behavior. Since each age group is characterized by lower mean self-assessment skills in providing medication instructions to patients, modifying the skills included in role-plays would be useful to improve their weaknesses.