Generative artificial intelligence (AI), such as ChatGPT, is rapidly becoming popular and is expected to be utilized in pharmacy practice; however, the current utilization status and usefulness of generative AI are not well understood. Therefore, we aimed to review its current utilization status and assess its potential for use in pharmacy practice.

The literature review revealed that most studies evaluated the accuracy and completeness of responses from generative AI. ChatGPT-3.5 was reported to be less valuable owing to many errors but could be used in text summarization. ChatGPT-4 was reported to be superior to ChatGPT-3.5; however, its performance was still considered insufficient. The comparisons among the generative AIs were not sufficiently investigated. In conclusion, generative AI can potentially help clinical pharmacists in the future; however, its features and performance should be carefully monitored and evaluated using the latest version of generative AI when applied to pharmacy practice.

Many immunoassay methods have been developed for quantifying vancomycin levels in biological fluids. Recently, the LM1010, a high-performance liquid chromatography-based medical diagnostic device was approved. This study compared the results obtained with LM1010 with those obtained using ARCHITECT plus chemiluminescent immunoassay (CLIA) to measure vancomycin levels in patient serum samples. The retention times measured with LM1010 for vancomycin and its major and minor crystalline degradation products (CDP-1) were 2.50, 2.38, and 1.91 min, respectively, and the separation was satisfactory. When five CLIA calibrator samples (5.0 – 100 μg/mL) were analyzed using LM1010, the concentrations were lower than expected, with an average of −12.96％ (range: −7.07％ to −17.53％). In addition, in a Japanese external quality control survey examination, LM1010 demonstrated high accuracy (0.33％ to −6.68％). A strong correlation was observed between the results obtained using LM1010 (calculated by peak height) and CLIA (r = 0.9682). The slope of the Deming regression comparing LM1010 to CLIA was 0.831, and a Bland–Altman plot for LM1010 relative to CLIA showed a mean negative bias (±1.96 standard deviation) of −2.356 (−6.108 – 1.396) μg/mL. Thus, the results obtained with CLIA were higher than those obtained with LM1010. If the calibrators for CLIA are adjusted by considering cross-reactivities with CDP-1 or other metabolites, the vancomycin concentrations in patient samples determined using CLIA may be higher than those determined using LM1010. Overall, vancomycin concentrations should be analyzed using an assay with higher accuracy, such as LM1010.

The Japan Pharmaceutical Association proposed a new category of over-the-counter (OTC) drugs, tentatively termed “common-use pharmaceuticals for both medical and general use,” in their “Policy Proposal 2022.” This new category will be classified as “Class 0,” meaning the risk classification will remain unchanged. Consequently, pharmacists will be responsible for providing information and selling these products. Understanding pharmacists’ perceptions of this policy proposal is crucial for developing a framework for this new category; however, no relevant evidence exists. Therefore, this study conducted a web-based, anonymous, self-administered questionnaire survey targeting pharmacists in hospitals, health insurance pharmacies, and drugstores to investigate their awareness and views on the proposal. The results revealed that less than 30％ of the pharmacists, regardless of their job role (hospital, health insurance pharmacy, or drugstore), were aware of the proposal, indicating a low level of awareness. However, regardless of their awareness at the time of the survey, more than half of the respondents expressed support for establishing these common-use pharmaceuticals, with few opposing the idea. Many pharmacists identified cold remedies, antitussives/expectorants, antipyretic analgesics, digestive medications, topical medications (eg, patches), and allergy medications as medical drugs that should be classified under the new category. This study is the first to offer insight into pharmacist awareness and views regarding the establishment of common-use pharmaceuticals, providing evidence for future discussions.

In 2016, at Kobe University Hospital, we started collaborations with community pharmacies using the tracing report (TR). Under the promulgation of the Act Partially Amending on Securing Quality, Efficacy, and Safety of Products Including Pharmaceuticals and Medical Devices in December 2019 and the revision of medical fees in 2020, the environment of collaboration between hospitals and community pharmacies for outpatient cancer pharmacotherapy has changed. Furthermore, in 2021, the Hyogo Pharmaceutical Association and the Hyogo Hospital Pharmaceutical Association jointly developed a new common TR form focusing on assessing adverse events in cancer pharmacotherapy; this TR is currently being used in our hospital. In this study, we investigated the effects of these environmental changes and the collaboration system on the content of TR and physicians’ responses from January to March in each year of 2019 – 2021, and from June to August in 2022. The number of TRs received in each period remained almost constant; however, the proportion of the telephone follow-up as a means of gathering patient information increased compared with the previous periods. The number of reports on adverse events was also higher alongside the number of physician responses to TR. These results indicate the improved quality of pharmaceutical interventions owing to changes in legislation and reimbursement as well as the introduction of the new TR form.

Here we evaluated—under normal and severe conditions—the stabilities of two types of zinc acetate preparations: the original drug, NOBELZIN^® 25 mg (A-25) and NOBELZIN^® 50 mg (A-50), Nobelpharma CO, Ltd; and the generic drugs, B-25 and B-50, Company b. We also examined the stabilities of the zinc histidine complex preparations, Zintus^® 25 mg (C-25) and Zintus^® 50 mg (C-50), Nobelpharma CO, Ltd. Our results demonstrated that when exposed to the environmental conditions of 30℃and 75％ relative humidity (RH) typical in Japanese summer for 3 months, the two zinc acetate preparations exhibited decreased dissolution testing results because of the generation of water-insoluble zinc compounds as follows: A-25 decreased to 72.0 ± 7.6％ of baseline, A-50 to 75.8 ± 2.1％, B-25 to 74.7 ± 4.6％, and B-50 to 73.9 ± 4.9％. In contrast, after exposure to harsher environmental conditions of 40℃and 75％ RH for 3 months, the zinc histidine preparations maintained the dissolution testing results observed before exposure: C-25 maintained 98.2 ± 1.0％ of baseline, and C-50 100 ± 1.2％ of baseline. After 3 months of exposure to severe environmental conditions, the zinc acetate preparations exhibited substantially decreased dissolution testing results: A-25 to 27.0 ± 5.8％ of baseline, and A-50 to 31.0 ± 7.4％. These results indicate that the zinc histidine preparation can be expected to maintain zinc stability without packaging, even under harsh conditions. This information can contribute to improved medication adherence without concerns about single-dose packaging, thereby providing more stable therapeutic effects.

Kampo medicines are expected to treat adverse reactions to anticancer drug therapy; however, substantial objective clinical evidence is lacking. Aiming to generate foundational information that will contribute to the future active evaluation of the efficacy and promotion of the prescription of Kampo medicines, i) a detailed survey of the prescriptions of Kampo medicines was conducted for 2,158 patients aged 15 – 65 years who underwent anticancer drug therapy at Kumamoto University Hospital between January – December 2020. Kampo medicines were prescribed to 318 patients (2,121 prescriptions in total): Daikenchuto (123 patients; 1,019 prescriptions), Shakuyakukanzoto (59; 247), Goshajinkigan (39; 312), Hangeshashinto (34; 229), Rikkunshito (22; 106), Goreisan (15; 82), and others (26; 126). Goshajinkigan is most commonly prescribed for supportive care of patients with cancer. Unlike other Kampo medicines, Goshajinkigan tended to be prescribed in outpatient settings and was most frequently prescribed in the gynecology department (21 patients, 53.8％). Then, ii) the effect of Goshajinkigan on chemotherapy-induced peripheral neuropathy (CIPN) was retrospectively analyzed in 13 patients who were treated with paclitaxel/carboplatin therapy in gynecology from January 2017 to December 2021 and developed CIPN (CTCAE Grade ≥1). CIPN Grade was significantly lower after the administration of Goshajinkigan compared with that before (P = 0.020). In conclusion, we have clarified for the first time the actual prescription status of Kampo medicine for patients with various cancers. Furthermore, Goshajinkigan, which was the most commonly used Kampo medicine for supportive care in the above survey, was found to be effective for CIPN.

Posaconazole (PSCZ) is a member of the azole class of antifungals used for the prophylaxis and treatment of invasive fungal infections. PSCZ exhibits fungistatic activity against most Candida, Aspergillus, and Mucor species. Hypokalemia associated with PSCZ is a major adverse effect that increases treatment discontinuation risk. This study was conducted to examine hypokalemia occurrence and its primary causes in 57 patients treated with PSCZ. Our results demonstrated that the incidence of hypokalemia was 29.8％. The median time to onset of hypokalemia was 7 days, with 76.5％ developing hypokalemia within 10 days, thereby indicating a tendency for hypokalemia to develop from the early stages of treatment; therefore, the risk factors for hypokalemia in patients who developed hypokalemia within 10 days were examined. As a result of the logistic regression analysis, T-Bil (≧0.7 mg/dL) (OR = 9.77, 95％ CI = 1.10 – 87.10, P = 0.041) was detected as a significant factor. It is important to regularly monitor serum potassium levels and adjust for the presence of hypokalemia.

The medications for preoperative drug withdrawal vary widely depending on the type of surgery and anesthesia; it is difficult to check all medications a patient is taking, including those prescribed by other hospitals, during an outpatient consultation and provide guidance on drug withdrawal. In this study, we examined the role of opening a hospitalization and discharge support (“Center”) and having a pharmacist provide explanations. We also examined the factors that caused noncompliance with medication withdrawal when doctors and nurses confirmed drug information and provided guidance on preoperative medication withdrawal without establishing a Center. The drug withdrawal noncompliance rate before the Center opened was 13.5％; however, it significantly decreased to 2.4％ after the Center opened. Furthermore, no more patients failed to receive medication withdrawal instructions from the medical staff after establishing a Center (before pharmacist intervention: 33 cases). In addition, the rate of requiring surgical postponement or anesthesia changed significantly from 1.83％ (before opening) to 0.20％ (after opening).

Regarding the factors of noncompliance with drug withdrawal before establishing a Center, patients may become non-compliant with drug withdrawal when their prescriptions at other hospitals contain drugs subject to preoperative withdrawal (failure to give withdrawal instructions). These results suggest the importance of comprehensively reviewing patients’ prescribed medications to more accurately implement preoperative withdrawal, especially when prescriptions from other hospitals contain medications subject to preoperative withdrawal.

The risk of vancomycin (VCM)-induced nephrotoxicity is reported when the area under the time-concentration curve (AUC) at steady state is greater than 600 μg·h/mL. There are few reports of AUC in the early stages of nephrotoxicity. Because acute kidney injury in critically ill patients has been suggested to have an impact on prognosis, nephrotoxicity should be managed early stage. Therefore, we examined the relationship between early AUC (i.e., AUC from 24 to 48 h [AUC_24–48h]) and early nephrotoxicity. This retrospective observational study included patients admitted to the intensive care and high care units of the emergency department from April 2019 to March 2024. Early nephrotoxicity incidence was compared between AUC_24–48h ≥600 group and AUC_24–48h <600 group. The analysis was performed using propensity score matching. Early nephrotoxicity incidence was significantly higher in the AUC_24–48h ≥600 group than in the AUC_24–48h <600 group (52％ versus 17％ P < 0.03). Multivariate logistic regression analysis demonstrated that “AUC_24–48h ≥600” and “AUC within 24h (AUC_0–24h) ≥600” were independent factors related to early nephrotoxicity.

The results of this study suggest that AUC_24–48h should be monitored at less than 600 μg·h/mL to avoid early nephrotoxicity in critically ill patients who are administered VCM.

In April 2023, we revised the forms required to calculate an enhanced collaborative model care fee. The anticancer agent follow-up sheet used by community pharmacists was also revised in September 2023 and was designed to automatically highlight potential adverse events that would require monitoring once an anticancer agent was selected. We investigated the number of cases for which an enhanced collaborative model care fee was calculated and the number of cases for which information was provided by community pharmacists over three periods: Period 1 from October 1, 2022 to March 31, 2023; Period 2 from April 1, 2023 to September 30, 2023; and Period 3 from October 1, 2023 to March 31, 2024. The number of cases with calculated enhanced collaborative model care fee significantly increased from 234 cases in Period 1 to 969 cases in Period 2 and 1087 cases in Period 3. Based on the information provided by community pharmacists, the number of follow-up patients receiving injectable anticancer agents increased significantly in Period 3 compared with Periods 1 and 2, with four cases identified in Period 1, 11 in Period 2, and 34 in Period 3. These results suggest that providing community pharmacists with specific information through enhanced collaborative model care fee and using the anticancer agent follow-up sheet by community pharmacists helped improve follow-up assessments on various cancer chemotherapy regimens.