A single-trough blood concentration (C0) point is considered useful in the therapeutic drug monitoring of tacrolimus (Tac). However, whether or not the relationship between C0 and area under the concentration time curve (AUC) changes when a proton pump inhibitor (PPI), which is potentially interacted with Tac, is concomitantly used remains unclear.

This retrospective study included renal transplant recipients who were taking Graceptor^® for immunosuppression, admitted to this hospital between January 2016 and March 2021, and evaluated for AUC0–12 of Tac. The relationship between C0 and the AUC was plotted and examined with and without concomitant PPI (rabeprazole or lansoprazole) use.

The relationship between C0 and AUC0–12 in 79 subjects is expressed as y = 21.0x + 37.3, R² = 0.805 in the group with PPI and y = 21.9x + 24.5, R² = 0.881 in the group without PPI, yielding a correlation coefficient difference of T = 1.12 (P = 0.263). However, in subpopulations with a low dose-adjusted trough concentration (C0/D) ratio defined as C0/D lower than 50 [(ng/mL)/(mg/kg/d)] and the intermediate (C0/D 50 – 100) group, the correlation coefficients between C0 and AUC with concomitant PPI were R² = 0.742 and R² = 0.586, respectively.

In conclusion, rabeprazole or lansoprazole has no clinically significant effect on the relationship between C0 and AUC of Tac in renal transplant recipients. However, in cases with Tac C0/D less than 100, the AUC evaluation by multiple blood sampling is recommended in that PPI use may affect the good correlation with C0 and AUC.

We conducted a questionnaire survey to evaluate the state of cooperation between the hospitals and the community pharmacies (CPs) in Ishikawa Prefecture with relevance to cardiovascular disease patients and the methods of cooperation expected by both parties. The response rates were 48.7％ (38/78) and 27.5％ (101/367) for the hospitals and the CPs, respectively. 71％ and 73％ of the hospitals and the CPs, respectively, rarely or never provided spontaneous information. The information format provided by the hospitals to the CPs was found to be consistent with CPs’ desires. The most common form of information provided by the CPs to the hospitals was tracing reports (70％), whereas the most common form of information preferred by the hospitals was medication notebooks (61％). The most common information provided to the CPs by the hospitals was prescription details (96％), which were different from the information types desired by the CPs, that is, disease name (84％) and progress during hospitalization (82％). The most common information provided to the hospitals by the CPs was prescription details (56％) and medication adherence/compliance (56％), which were also the most common information types desired by the hospitals. Therefore, cooperation going on between the hospitals and the CPs in Ishikawa Prefecture is insufficient. Differences were found in the format and content of information desired by both parties. A discrepancy was noted between the actual and desired formats and content of information provision, as well. Establishing cooperation rules fulfilled the needs of both parties will further promote cooperation between hospitals and CPs.

Drug information (DI) has recently become increasingly complex and extensive. DI sources have also diversified. However, how hospital pharmacists involved in advanced medical care utilize DI sources in actual clinical practice, how they collect information, and how they supplement any missing information remain unclear. This survey involved 166 hospital pharmacists in charge of DI who were registered with Nikkei Medical and passed the screening survey. The survey was conducted online and investigated the utilization status of various DI sources, methods of supplementing missing DI, and access availability. The responses were analyzed based on respondent attributes, such as the type of hospital they worked in and their qualifications. The survey results showed that package inserts and interview forms are the most commonly utilized sources of DI. The utilization rate of interview forms in general hospitals was higher than that in specialized-function hospitals. Moreover, those who used advanced DI, such as review reports and common technical documents, showed high utilization rates in other DI sources. Regarding supplementing methods, contacting pharmaceutical companies was found to be the most common approach, and those with qualifications tended to have a higher proportion of responding with “conducting their own research” compared to those without qualifications. While missing DI can be obtained to some extent through various supplementary methods, the item of “Milling, Decapsulating” was identified as DI that is difficult to supplement, regardless of the method used.

Adverse events (AEs) must be reported by pharmacists. However, the existence of an educational system guiding pharmacists to accurately produce high-quality AE reports is unknown. This study aimed to examine pharmacists’ case report educational system for reporting AEs via a survey and construct an educational foundation for AE reporting. A questionnaire was administered to the pharmacists working in the target hospitals. A case report educational system was developed for three hospitals, namely, Showa University Fujigaoka Hospital, Kawasaki Municipal Tama Hospital, and Hitachi General Hospital. Pharmacists across the nation exhibited little knowledge about the terms related to reporting AEs. Only 30％ of the respondents were familiar with the Naranjo score, Drug Interaction Probability Scale, and CARE (for case reports) guidelines. Moreover, only 14.3％ and 21.3％ of the pharmacists had experience of teaching and writing case reports, respectively. Results of the 1^st-year survey conducted at the three facilities were similar to those of the nationwide survey, stating that knowledge related to AE reporting has improved, and the number of conference presentations and case report publications has increased after the 2^nd year. Therefore, establishing an educational foundation for reporting AEs may improve pharmacists’ knowledge and outcomes over time and increase satisfaction. Case report education is particularly effective for pharmacists with ≥10 years of experience. This finding will potentially impact young pharmacists in the future.

A polypharmacy countermeasure team was established at Hiroshima City North Medical Center Asa Citizens Hospital to optimize prescriptions. Whenever possible, an Information Liaison Form was used to provide community pharmacists and primary care physicians with information regarding medication adjustments made during hospitalization. However, the maintenance status of prescriptions after discharge for patients who underwent medication adjustments was not monitored. Herein, we surveyed the medications brought in by patients with heart failure who were readmitted after undergoing medication adjustments by the polypharmacy countermeasure team to investigate the maintenance status of their prescriptions. When the Information Liaison Form was used to provide information, notably only a few drugs that had been discontinued during hospitalization were represcribed, indicating that postdiscontinuation prescriptions were maintained. Therefore, pharmacists who provide information using the Information Liaison Form help maintain discontinued prescriptions after patient discharge.