Saccharated ferric oxide is an iron preparation for intravenous injection obtained by colloidal particles of ferric hydroxide with sucrose. Although it is necessary to dilute saccharated ferric oxide with a 10-20％ glucose injection solution according to the product labeling, it is often diluted with 5％ glucose injection solution and/or saline in clinical practice. In the present study, we evaluated the stability of saccharated ferric oxide in various diluted solutions in terms of the abundance of free iron ions. The abundance ratio of free iron ions significantly increased with pH elevation of the diluted solution. Moreover, a marked decrease in the abundance ratio of free iron ions was observed in the sodium chloride solution exceeding the physiological concentration (0.9％). Furthermore, a statistical decrease in the abundance ratio of free iron ions was confirmed in the glucose solution compared to saline, and the degree of liberation of free iron ions in 5％ glucose solution was the lowest among various concentrations of glucose solution. These results indicate the possibility that saccharated ferric oxide can be diluted by 5％ glucose injection solution with minimal effects on its stability, although its dilution according to the product labeling is basically important.
Rituximab (RIT) is a mouse-human chimeric anti-CD20 monoclonal antibody that is one of the key drugs for the treatment of CD20-positive B cell non-Hodgkin lymphoma (B-NHL). Although RIT frequently causes infusion reactions (IR) during initial administration, there have been few reports about the frequency and risk factors for IR during re-administration of RIT to patients with recurrence. In this study, we investigated the frequency of clinically relevant IR (Grade ≥ 2) that occurred during re-administration of RIT and the risk factors for such IR. Twenty patients (31％) developed IR (Grade ≥ 2). These reactions commonly occurred at an infusion rate of 100 mg/hr, but some patients developed IR after the completion of rituximab administration. In addition, the incidence of IR during re-administration of RIT was significantly higher among patients who had developed IR at the time of initial administration [Odds ratio 4.74 (95％ CI 1.28 - 17.5, P = 0.012)]. When patients receive re-administration of RIT, it is necessary to pay careful attention to IR in the same way as at the time of initial administration. In particular, the re-administration of rituximab to patients at high risk of developing IR should be performed carefully, including inpatient management.
Stomatitis is one of the most common side effects caused by anticancer agents. Serious stomatitis leads to eating disorders and deteriorates quality of life significantly. However, no effective treatment has been established. Both sodium azulene sulfonate and tranexamic acid are generally used for stomatitis. Here, we aimed to assess the mouthwash containing these two drugs (A + T mouthwash) for the treatment of chemotherapy-induced stomatitis. In this study, we retrospectively investigated the grade of stomatitis (Common Terminology Criteria for Adverse Events version 4.0) and subjective symptom before and after the use of A + T mouthwash in cancer patients receiving chemotherapy, and assessed the efficacy of A + T mouthwash against chemotherapy-induced stomatitis.
Forty-four cancer patients (gastric, colon, cholecystitis, breast, ovarian and unknown primary cancer) were included in this study. The severity of stomatitis was significantly improved after using A + T mouthwash compared to before using it (P < 0.05). Of the 44 patients, the grade was improved in 25 patients (56.8％) and the subjective symptom was improved in 36 patients (81.8％). These results suggest that A + T mouthwash is effective for chemotherapy-induced stomatitis.
We experienced a case, in which a hospital pharmacist and community pharmacist cooperated by utilizing the pharmacist outpatient service and telephone follow-up, and continued to intervene in medication management and side effect monitoring of the outpatient.
Case report: The male patient in his 70s, with thyroid carcinoma metastasized to lung after receiving total thyroidectomy, was treated with radioactive iodine. However, because the radioactive iodine had no effect, he was treated with lenvatinib. Afterward, as he continued with outpatient treatment, he experienced a rise in blood pressure and hand-foot syndrome induced by lenvatinib. Then, the hospital pharmacist suggested the addition of azilsartan and amlodipine, and consultation with dermatology, to his attending doctor in the pharmacist outpatient service, and the community pharmacist assessed the effect of supportive care. By sharing information on the condition of the patient with each other, there was an improvement in the side effects and treatment of lenvatinib was continued. Furthermore, since confirmation that the medicine had been taken was conducted numerous times through cooperation between the hospital pharmacist and community pharmacist, he could continue treatment, and there was almost 100% compliance with the dosing protocol.
When we treat patients with medicine that potentially has serious side effects, we need to continue monitoring the side effects. Especially, in outpatients, cooperation between the hospital pharmacist and community pharmacist enables the provision of safer and better medical care.
L-thyroxine sodium (L-T4) tablets have been administered to patients with hypothyroidism; however, the tablets cannot be administered to patients who are unable to take drugs orally. As the injection formulations are not supplied commercially in Japan, the L-T4 injection formulations are prepared in the hospital for use. In this study, we investigated the stability of L-T4 injection formulations and evaluated the decomposition rate constant (kd) using kinetic analysis. The L-T4 injection formulations were stored in tight and hermetic containers under -80℃, -30℃, 4℃, 20℃, and 30℃. The residual ratio of the L-T4 in the hermetic containers was higher than that in the tight container, and the kd in tight and hermetic containers at 20℃ was 44.38 × 10-3/d and 3.357 × 10-3/d, respectively. The decomposition of L-T4 in the hermetic container under 4℃ was low 1 month after the preparation. Moreover, the frozen storage significantly prevented the decomposition of L-T4, and the decomposition was low after a 6-month period. In conclusion, our results indicate that L-T4 injection formulations prepared in a hospital can maintain a satisfactory quality under refrigeration or in frozen storage for over 1 month and 6 months, respectively. These results support previous reports on L-T4 injection formulations and provide significant information for long-term stability of L-T4.
We have recently found the H+/quinidine (QND) antiport system in canine kidney MDCK, porcine kidney LLC-PK1, and human embryonic kidney (HEK) 293 cells. The aim of the present study was to explore the biological materials responsible for an H+/lipophilic cation antiport system in renal tubular cells. We prepared phosphatidyl choline (PC) liposomes and phosphatidyl serine (PS)-containing PC/PS liposomes, and investigated the uptake of lipophilic organic cations.The uptake of 100 µM bisoprolol (BIS) into PC and PC/PS liposomes was increased by the alkalization of medium pH, and the uptake of the drug into PC/PS liposomes was significantly greater than that into PC liposomes. In addition, a lipophilic cationic drug, diphenhydramine (DPH), significantly decreased the BIS uptake in PC/PS liposomes. The Michaelis-Menten constant (Km) for BIS was lower in PC/PS liposomes than in PC liposomes.The uptake of 11 cationic compounds (celiprolol, acebutolol, procainamide, pindolol, BIS, metoprolol, flecainide, clonidine, pyrilamine, QND, and propranolol) into PC/PS liposomes, as well as that into HEK293 cells, was positively correlated with their lipophilicity (Log D) values, and tended to be negatively correlated with their polar surface area (Log PSA) values. These findings suggest that phospholipids are, at least partly, responsible for the postulated H+/lipophilic cation antiport system in the kidney.
The role of community pharmacists in the management of inhalation therapy is expanding; however, they feel that the issues of inhalation instruction have not been clarified. To examine such issues based on self-evaluation by community pharmacists, we conducted a questionnaire survey on 43 community pharmacists. The results of the questionnaire were analyzed using customer satisfaction analysis, with the improvement index as the primary endpoint. As a result of the customer satisfaction analysis, “Home medical support (improvement index 12.69)”, “Continuity of inhalation instruction (11.09)”, and “Relationships with patients (7.64)” were shown as issues to be improved. In the practice of inhalation instruction by community pharmacists, overcoming these issues can improve their self-evaluation and may lead to better outcomes for inhalation therapy.