Aim: To investigate the attitude toward polypharmacy among family doctors and pharmacists in Kanagawa prefecture.

Methods: A questionnaire survey was conducted to 2,448 medical facilities advocating internal medicine, surgery, or orthopedics, and to 2,415 pharmacies.

Results: More than 90% of both doctors and pharmacists understood the importance of polypharmacy and thought that 90% of doctors and pharmacies had been regularly coping with polypharmacy. However, although Ministry of Health, Labour and Welfare of Japan’s guidelines are considered useful, the utilization rate was less than 7.2% for both. For the causes of polypharmacy, doctors or pharmacists answered that they were due to visits to multiple medical facilities (82.1%, 79.7%), having multiple symptoms (65.7%, 48.5%), and drugs requests from the patient (43.7%, 59.9%), which are related to patients’ conditions or attitudes. Pharmacists also answered that prescribing cascade (59.2%) and insufficient understanding of medication status (55.1%) which are related to doctors’ attitude were also related to incidence of polypharmacy. Most pharmacists wanted to reduce drugs, but only 47.3% answered that they had made a proposal for deprescribing to doctors.

Conclusions: Actions against polypharmacy are necessary in a super-aging society, and it is important to disseminate and utilize the relevant guidelines. The results described that proposal for changing drugs to doctors were still difficult for pharmacists, and that doctors and pharmacists should have better relationship to facilitate the process of checking adverse drug events, medication adherence of older patients.

Objective: To determine the actual status of lemborexant (LEM) prescriptions in the elderly in clinical practice.

Methods: The LEM prescription status was compared between elderly (age: ≥ 65 years) and non-elderly (< 65 years) patients admitted to Fukuoka University Hospital who started LEM treatment under sleeping pill conditions.

Results: The induction dose of LEM was lower in elderly patients than in the non-elderly patients and significantly increased by the time of discharge. The LEM prescription continuation rates of the elderly and non-elderly patients did not differ to a statistically significant extent. The usage of benzodiazepine (BZD) receptor agonists were significantly reduced immediately after LEM induction in elderly patients, with a particularly high proportion of patients receiving reduced doses of ultra-short- and short-acting drugs. There were no significant differences in the occurrence of adverse events or reasons for discontinuation between the elderly and non-elderly patients.

Conclusion: LEM was well tolerated by elderly and non-elderly patients, and may contribute to reducing the usage of BZD receptor agonists.

Background: Issues concerning polypharmacy and intervention methods according to specialized fields require investigation. The aim of the present study was to investigate the situation surrounding drug use in neurology and compare it with other fields.

Methods: We targeted inpatients in the neurology ward of national center of neurology and psychiatry in Japan and compare with other wards of national center in Japan from September 1 to November 30, 2021, and surveyed issues concerning polypharmacy.

Results: We enrolled 113 participants with an age of 66 (54-75) years. Neurology tends to have a higher number of oral medications used (9, 6-11, p < 0.01) and more frequent doses per day (4, 3-5, p < 0.01) with other fields. The most common diseases upon hospitalization are Parkinson’s disease (31.9%) and multiple system atrophy (14.2%). Of all participants, 70.8% have designated intractable diseases. Levodopa and carbidopa hydrate (38.9%) are the most commonly used drugs, followed by magnesium oxide (25.7%) and clonazepam (21.2%). This indicates that the medications for Parkinson’s disease are the most commonly used drugs in neurology. Further, the most frequent subjective symptoms are dizziness/lightheadedness (29.2%, p＝0.15), falls (23.9%, p < 0.01), and dysphagia (21.2%, p < 0.01).

Conclusions: This study clarified matters concerning the situation of drug use and polypharmacy in the field of neurology; as such, this will be useful when examining intervention methods according to specialized fields. We intend to use the results of this study as a reference for resolving issues concerning polypharmacy and performing safe and appropriate pharmaceutical interventions.

The medical role of dementia support team (DST) is increasing with an increasing number of dementia patients. Since Hashima City Hospital lacks a psychiatry department, pharmacists are expected to perform DST activities. Therefore, we retrospectively investigated cases in which pharmacists prescribed medications. Of the 126 patients, 61% (77/126) were suggested prescriptions by pharmacists. The percentage of patients who were taking two or more concomitant sleeping medications decreased statistically significantly (P < 0.01) at the time of discharge compared with the time before admission, and the percentage of patients who were taking benzodiazepines (BZ) or non-BZ sleeping medications tended to decrease at the time of discharge compared with the time before admission. On the other hand, other sleep medications significantly (P < 0.01) increased at discharge compared to pre-hospitalization．The outcome of sleep disturbances improved 81% (21/26). Thus, pharmacists participating in DST and prescribing antipsychotics and sleeping pills can help ensure the proper use of sleeping pills.

Adverse effects of benzodiazepines and nonbenzodiazepines include tolerance due to physical dependence, muscle relaxant effect, lightheadedness, and falls, which are particularly serious problems in the elderly. The conventional methods of discontinuation of these sleeping pills have been the tapering method, the every-other-day method, and the substitution method. However, there are few reports on the efficacy and safety of the substitution method in the elderly. Lemborexant, an orexin receptor antagonist, has attracted much attention because of the lack of adverse effects reported with benzodiazepines and nonbenzodiazepines. Trazodone has also been reported to reduce the frequency of awakenings and withdrawal symptoms. In the present study, we have conducted an outpatient analysis of an elderly patient on long-term benzodiazepine and nonbenzodiazepine sleeping pills who had been experiencing side effects such as periodic lightheadedness and carryover to the next day, and the patient was anxious about the side effects. Not only the conventional tapering method and the every-other-day method, but also the substitution method could be used without any side effects such as withdrawal symptoms and insomnia. The results also suggest that lemborexant and trazodone can be substitutes for benzodiazepines and nonbenzodiazepines without lowering sleep quality.