Polypharmacy increases the risk of drug–drug interactions (DDIs) among patients with psychiatric disorders. Several psychiatric medications act as substrates, inhibitors, or inducers of cytochrome P450 (CYP), necessitating careful evaluation of CYP-mediated DDIs before administration. This study aimed to evaluate the potential risk of CYP-mediated DDIs among psychiatric inpatients.

We included inpatients discharged from the psychiatric ward of The University of Tokyo Hospital between April 2022 and March 2023; we also identified CYP isoform substrates, inhibitors, and inducers for medications prescribed at discharge. Thresholds of ≥0.3 were set for the contribution ratio of CYPs to the oral clearance of substrates, the inhibition ratio of inhibitors, and the induction-related increase in clearance to predict changes in the area under the concentration-time curve (AUC) of the substrate and evaluate DDI risk.

A total of 292 patients were analyzed. The most commonly prescribed substrates were for CYP3A (236 patients; 80.8％) and CYP2D6 (153 patients; 52.4％). The most frequently prescribed inhibitors targeted CYP2D6 (74 patients; 25.3％) and CYP2C19 (55 patients; 18.8％), whereas inducers were most commonly prescribed for CYP3A (10 patients; 3.4％). In total, 62 potential CYP-mediated DDIs with a substrate drug AUC ratio of ≥ 1.5-fold or <two-thirds were detected in 42 patients (14.4％). Among patients taking six or more medications (179 patients), 36 (20.1％) exhibited CYP-mediated DDIs, often because of prescriptions from other specialties.

In conclusion, this study underscores the importance of careful medication management to mitigate the potential risk of CYP-mediated DDIs in psychiatric inpatients.

Pharmaceutical inquiries regarding prescriptions play a crucial role for pharmacists in ensuring the efficacy and safety of medications. While it is essential to transcribe inquiry responses into prescriptions, the limitation lies in effectively conveying the inquiry’s contents to a diverse range of professionals by simply entering them into the formulary. This study investigated the effects of implementing a new system by sharing information among various professionals, where the details of pharmaceutical inquiries and their responses were documented in electronic medical records. The study was conducted at Kyoto University Hospital from January to June 2022 (pre-system introduction) and from July to December 2022 (post-system introduction). The number and content of pharmaceutical inquiries and the time taken to modify prescriptions were analyzed. Furthermore, the system was evaluated through a questionnaire survey targeting doctors and nurses. Although no significant changes were observed in the number or content of pharmaceutical inquiries, the time required to modify prescriptions was significantly reduced (pre-system introduction = 33 min; post-system introduction = 16 min; P < 0.05). Questionnaire responses revealed that approximately 70％ of the doctors and 50％ of the nurses recognized the system’s value in enhancing medical safety, improving prescriptions, and reducing working hours. These findings suggest that sharing pharmaceutical inquiry information with a diverse range of professionals improves workflow, while simultaneously enhancing medical safety and prescription efficiency.

Exposure to anticancer drugs among healthcare professionals is a significant occupational safety concern. In our institution, instances of drug splatter during the initial puncture of the vials frequently occur despite adherence to preparation protocols. We hypothesized that elevation might contribute to this phenomenon. To investigate this, we compared the internal pressure of the vials and the amount of drug splatter between a low-elevation facility (reference facility) and our high-elevation institution. The results indicated that the pressure differential in the vials at the reference facility ranged from −2.7 to 1.6 kPa, whereas it ranged from 5.2 to 9.7 kPa at our institution, demonstrating a clear positive pressure in the vials at our facility compared to the reference facility. In addition, the total amount of drug splatter was significantly higher at our institution, ranging from 1,199 to 2,909 μg, compared to 0.124 – 183 μg at the reference facility. These findings suggest that increased elevation leads to positive pressure within the vials, which facilitates drug splatter. This phenomenon poses a considerable risk to the preparers. We believe that addressing this issue will contribute to the establishment of a safer preparation environment.

Tablet and capsule packaging includes PTP (press-through pack) and SP (strip package) packaging, and the number of sheets packaged varies widely. Although no evidence or guidelines exist regarding the number of units per package, pharmaceutical companies set their own packaging standards. The wide variety of packaging configurations used by pharmacists for dispensing may increase the risk of dispensing errors. To examine this issue, we conducted a survey of pharmacists working in insurance pharmacies and hospitals and asked them about their preferred number of units per package. Most respondents supported 10-pill packaging, citing reasons such as ease of management and prevention of dispensing errors. For most dosage regimens, the highest number of respondents preferred the 10-pill package, except in cases of once-weekly or once-monthly dosages. Therefore, we propose that the number of tablets and capsules per PTP and SP package should be standardized to 10 tablets.

Amrubicin hydrochloride (AMR) is widely used as a second- or later-line treatment for small cell lung cancer; it is classified as an anticancer drug with moderate emetic risk. For an anticancer drug with moderate emetic risk, it is recommended to administer a first-generation 5-hydroxytryptamine 3 (5-HT₃) receptor antagonist plus dexamethasone (DEX) 9.9 mg on Day 1 for preventing acute-phase chemotherapy-induced nausea and vomiting (CINV) and DEX 8 mg on Days 2 – 3 to prevent delayed-phase CINV. However, no studies have the optimal antiemetic regimen for AMR monotherapy administered over 3 consecutive days, and it remains uncertain whether DEX should be administered on Days 4 and 5. In this study, we investigated CINV incidence among patients receiving AMR monotherapy without DEX administration on Days 4 and 5. We conducted a retrospective analysis of medical records, evaluating CINV in 38 patients with lung cancer who received AMR monotherapy during hospitalization at Komaki City Hospital from 2016 to 2023. The total control rate for nausea and vomiting (defined as the proportion of patients without nausea/vomiting and requiring no additional antiemetic treatment) during the observation period was 92.1％ (35 out of 38 patients). These findings suggest that AMR monotherapy, combined with first-generation 5-HT₃ receptor antagonists and 9.9 mg of DEX on Days 1 – 3, can effectively prevent CINV, including delayed-phase symptoms.

Mie Chuo Medical Center has introduced protocol-based pharmacotherapy management (PBPM) to facilitate the selection of an optimal saline solution to dissolve injectable medicines. The pharmacist could change the prescription according to the protocol. A plastic bottle of saline solution could be provided when a kit of saline solution was prescribed as the dissolving solution for injectable drugs in ampules or in vials other than integer numbers. The purpose of this study was to identify the percentage of injection orders that were changed to the optimal saline solution as a result of PBPM and to evaluate the economic and time benefits. The percentage of infection order changes to optimal saline solutions increased from 2.5％ (21/848) before PBPM introduction to 91.3％ (647/709) after PBPM (P < 0.05). The cost reduction for the 6 months after PBPM implementation was 46,865 yen, and the reduction in the enquiry times was 204 min. PBPM can be used to select the optimal saline solution to improve operational efficiency and to contribute to cost reduction.

A 79-year-old man with pulmonary tuberculosis was treated with four drugs: isoniazid, rifampicin, ethambutol, and pyrazinamide. The medication was temporarily discontinued and resumed multiple times through desensitization therapy due to adverse drug reactions. Ultimately, treatment was continued with isoniazid, levofloxacin hydrate, and ethionamide. A pharmacist detected the adverse reactions early by proactively monitoring the patient’s progress. On day 670 after starting the abovementioned four drugs, the patient reported anorexia and dysgeusia during an interview with a pharmacist before consulting a physician. Eleven days later, the pharmacist followed up and learned that the patient’s condition had worsened (Grade 3). The pharmacist suspected ethionamide-induced hypothyroidism and consulted a tuberculosis specialist, resulting in an unscheduled medical consultation for the patient. Blood tests showed free T3 < 1.50 pg/mL, free T4 < 0.40 ng/mL, and a thyroid-stimulating hormone level of 339.67 μIU/mL, confirming hypothyroidism. The patient’s symptoms improved with thyroid hormone therapy, allowing him to complete 3 years of treatment without discontinuing the medication.

This study examined medication and patient information exchange at pharmacies, focusing on perceived workload, willingness to pay (WTP) for healthcare digital transformation (DX) implementation, and related factors. This study systematically analyzed the relationships between these factors to explore the challenges in advancing DX use in pharmacies. The results indicated that while the exchange of medication and patient information has expanded, many respondents reported “inconvenience” and “burden by the efforts required to resolve issues related to information gaps.” These findings underscore the need to promote healthcare DX. Furthermore, regression analysis revealed that inconvenience in information exchange was associated with the presence of “medical institutions with which information is closely exchanged” and “medical institutions sending medication information reports [tracing reports (TR)].” Additionally, efforts to resolve information gaps were linked to pharmacies classified as “Pharmacy Basic Fee 1” and the presence of “inconvenience.” Furthermore, the WTP for DX implementation was associated with factors such as “number of group stores,” “number of prescriptions processed per pharmacist,” and “number of medical institutions responding to TR.” These findings highlight the challenges in managing medication and patient information exchange at pharmacies and provide insights into the direction of DX implementation.

Injection-delivered voriconazole (VRCZ), developed with sulfobutylether-β-cyclodextrin, could accumulate in the kidneys, adversely affecting their function. Therefore, VRCZ injections are generally not recommended for patients with a creatinine clearance (Ccr) < 50 mL/min. The effect of VRCZ injection for ≥1 week on the kidneys of patients with moderate-to-severe renal impairment at baseline remains unclear. Therefore, we retrospectively investigated renal function alterations and the incidence of acute kidney injury (AKI) by collecting data from 76 patients who received VRCZ injections for at least a week. Of the assessed patients, 13 displayed a Ccr < 50 mL/min at baseline (renal dysfunction group). No AKI incidence was observed in the renal dysfunction group. Among the patients with the Ccr ≥ 50 mL/min (normal renal function group), 11 out of 63 developed AKI. The normal renal function group had more patients taking at least three drugs with a potential risk of renal dysfunction than the renal dysfunction group (17 and 0 patients, respectively; P = 0.033). In conclusion, VRCZ injection might be used for ≥1 week without AKI, even in patients with renal dysfunction, especially when patients are free of potentially nephrotoxic agents. However, even patients with normal renal function could develop AKI during treatment with VRCZ injections, especially when combined with multiple drugs exhibiting the potential risk of renal impairment.